Extra-Cavitary Primary Effusion Lymphoma in a Patient Co-infected With HIV-1 and HIV-2: A Case Review

Abstract

Extra-cavitary primary effusion lymphoma (PEL), often associated with human herpes virus 8 (HHV8) infection, represents a rare and aggressive form of non-Hodgkin lymphoma, which is predominantly found in individuals with severe immunosuppression. As an acquired immunodeficiency syndrome (AIDS)-associated lymphoma, PEL typically manifests in the context of advanced human immunodeficiency virus (HIV) infection, requiring tailored therapeutic approaches to manage both the lymphoma and underlying immunodeficiency. A 53-year-old male patient from Cape Verde presented with a three-day history of fever, night sweats, right iliac fossa pain, hematochezia, and an unintentional weight loss of five kilograms over the previous two months. A laboratory study revealed a previously undiagnosed co-infection with HIV-1 and HIV-2, with a CD4+ T-cell count of 63/μL. The abdominal-pelvic computed tomography (CT) scan revealed hepatosplenomegaly with hypodense nodular lesions and prominent lymph nodes in the celiac-mesenteric, axillary, and cervical regions. Lung imaging showed non-specific nodules. An extensive investigation for opportunistic infections was conducted, with a bronchoalveolar lavage culture test positive for Mycobacterium xenopi and a colon biopsy indicating Cytomegalovirus colitis. Further histological examination from a gastric biopsy revealed the diagnosis of the solid variant of PEL. The patient initiated treatment for opportunistic infections followed by antiretroviral therapy. However, he experienced multiple complications and due to his deteriorating condition, chemotherapy was not initiated and he ultimately died. This rare clinical case of lymphoma in a patient co-infected with HIV-1 and HIV-2, the first of its kind to be reported, to the authors' knowledge, underscores the diagnostic and therapeutic challenges associated with this condition.

Keywords: aids related cancers; dual infection with hiv-1 and hiv-2; hiv; human herpes virus 8; non-hodgkin lymphoma; primary effusion lymphoma.

Figure 1. Abdominal CT Scan

Hepatosplenomegaly with hypodense nodular lesions (arrow) in the liver and prominent lymph nodes in the celiac-mesenteric region.

Figure 2. Histology

Histological section of a gastric biopsy stained with hematoxylin and eosin (H&E) showing clusters of abnormal lymphoid cells infiltrating the gastric mucosa (A). Immunohistochemical results: the tumor cells in the gastric biopsy show partial expression of CD30 (B); tumor cells positive for CD45 (C); nuclei of tumor cells positive for HHV-8 (D). HHV-8: Human herpes virus 8