A Rare Case of Plasmablastic Lymphoma in a Patient with HIV and SARS-CoV-2 Infections

Abstract

Lesions commonly associated with HIV infection include oral candidiasis, herpes simplex infection, oral Kaposi's sarcoma, hairy leukoplakia, periodontal diseases (linear gingival erythema and necrotizing ulcerative periodontitis), xerostomia, human papillomavirus-associated warts, aphthous ulcers, non-Hodgkin's lymphoma, histoplasmosis, carcinoma, exfoliative cheilitis, and HIV salivary gland disease. Non-Hodgkin's lymphoma (NHL) is the most common cancer in people living with HIV (PLWH), and the incidence is increased for aggressive B-cell NHL. Plasmablastic lymphoma (PbL) is a rare and aggressive B-cell malignancy that is often unresponsive to chemotherapy and usually has a poor prognosis. We hereby present the case of a patient with a recent history of COVID-19 infection who was diagnosed with HIV and NHL, with manifestations in the oral cavity and a favorable evolution after the introduction of antiviral therapy, specific chemotherapy, and radiotherapy. Dental expertise is necessary for the appropriate management of oral manifestations of HIV infection or AIDS, and lymphoma should be included in the differential diagnosis of any oral lesions.

Keywords: COVID-19; Epstein–Barr; HIV; non-Hodgkin’s lymphoma; oral manifestation.

Figure 1

Ulcer-vegetative tumor lesion in the oral cavity.

Figure 2

Plasmablastic lymphoma of the oral mucosa: (A) proliferation of large atypical cells with immunoblastic features (H&E stain, Ob. ×100); (B) negative immunostain for CD20 antibody (IHC, Ob. ×100); (C) intense and diffuse membranous immunostaining for CD38 antibody (IHC, Ob. ×100); (D) moderate and diffuse membranous and cytoplasmic immunostaining for Kappa antibody (IHC, Ob. ×100); (E) moderate and focal membranous and cytoplasmic immunostaining for lambda antibody (IHC, Ob. ×100); (F) intense and diffuse nuclear immunostaining for KI67 antibody, with a high KI67 index of −90% (IHC, Ob. ×100).