Associates' Presentations
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HIV and Lymphoma

Christopher G. Peterson, M.D., University of Wisconsin School of Medicine, Madison, WI

A 42-year-old white male, HIV+ since 1986 with a viral load of 4,900 copies/ml and CD (count of 288/ul) was referred from Janesville, WI for evaluation of erythema and induration along the superior right chest wall with axillary lymphadenopathy. He recalled pulling his arm at work, but no other trauma. Despite multiple different antibiotics, the cutaneous lesions progressed to involve the pectoralis muscle, axilla, and clavicular region. Multiple cultures, laboratory studies, and two biopsies failed to demonstrate and etiology. A third biopsy revealed anaplastic large cell lymphoma. The patient is currently receiving CHOP chemotherapy and has had great reduction in the extent of disease, however, problems with neutropenia and peripheral neuropathy required alterations in the patient's chemotherapy regimen.

As many as one in six HIV infected people will develop an HIV related neoplasm. Non-Hodgkin's Lymphoma (NHL) is now recognized as a common cancer in HIV+ patients, second only to Kaposi's sarcoma in incidence. In fact, it may represent the initial presentation in previously unknown HIV infected patients, or an HIV+ patients AIDS defining illness. The presentation can be quite variable and may be difficult to diagnose. In HIV, 80% of NHL's are systemic rather than nodal, originating most commonly in the central nervous system or GI tract although almost any extranodal site is possible. In contrast to this patient, the vast majorities are clinically aggressive B cell-derived neoplasms exhibiting Burkitt's lymphoma, large cell immunoblastic lymphoma, or large cell lymphoma histology. Although prognosis is generally poor, some predictors of survival have been identified.

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