Diffuse B-cell lymphoma in a child with HIV infection

Objective. To describe the case of diffuse B-cell lymphoma in a child with HIV infection.

Results. A 16-year-old child with HIV infection and generalized lymphadenopathy was diagnosed with diffuse large B-cell lymphoma, stage III, negative central nervous system. The patient was diagnosed on the basis of the results of immunohistochemical study of biopaths of the tissue of the lymph nodes of the submandibular and right axillary region. The study in order to identify markers of active infection caused by the Epstein-Barr virus, cytomegalovirus and human herpesvirus type 6, made it possible to exclude the active phase of diseases that are the main infectious causes of lymphoproliferative syndrome. At the time of hospitalization, the patient was treated with antiretroviral therapy of the combined drug Eviplera. There was no HIV RNA in the blood, the level of CD4 lymphocytes was 0.4·109/l. The BFM chemotherapy regimen was used, which was accompanied by positive dynamics in the form of normalization of body temperature, reduction in the size of lymph nodes.

Conclusion. This case shows that immunohistochemical examination of tissue biopsies of enlarged lymph nodes is of decisive importance in the diagnosis of lymphoma, the main non-infectious cause of lymphoproliferative syndrome in patients with HIV infection.

1. Morlat P., Roussillon C., Henard S., Salmon D., Bonnet F., Cacoub P. et al. Causes of death among HIV-infected patients in France in 2010 (national survey): trends since 2000. AIDS 2014; 28: 1181–1191. DOI: 10.1097/QAD.0000000000000222

2. Patel P., Hanson D.L., Sullivan P.S., Novak R.M., Moorman A.C., Tong T.C. et al. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med 2008; 148: 728–736. DOI: 10.7326/0003-4819-148-10-200805200-00005

3. Grulich A.E., van Leeuwen M.T., Falster M.O., Vajdic C.M. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007; 370: 59–67. DOI: 10.1016/S0140-6736(07)61050-2

4. Grogg K.L., Miller R.F., Dogan A. HIV infection and lymphoma. J Clin Pathol 2007; 60: 1365–1372. DOI: 10.1136/jcp.2007.051953

5. Misyurina А.E., Misyurin V.А., Baryakh E.А., Kovrigina А.M., Kravchenko S.K. The role of gene expression c-MYC, BCL2 and BCL6 in the pathogenesis of diffuse large B-cell lymphoma. Klinicheskaya onkogematologiya 2014; 7(4): 512–521. (in Russ.)

6. Msimang M.Z., Ramdial P.K., Kuppusamy J.B., Nargan K. AIDS-Associated Pediatric High Grade B-cell Lymphoma with MYC and BCL2 Translocations. J AIDS Clin Res 2017; 8: 11

7. Meister A., Hentrich M., Wyen C., Hübel K. Malignant lymphoma in the HIV-positive patient. Eur J Haematol 2018; 101: 119–126. DOI: 10.1111/ejh.13082

8. Aggressive non-follicular lymphomas – diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, Burkitt’s lymphoma. Clinical guidelines. Moscow, 2020; 520. (in Russ.)

9. Pivnik А.V., Tumanova M.V., Seregin N.V. Parhomenko Y.G., Tishkevitch O.A., Kovrigina A.M. et al. Lymphomas in HIV-infected patients: a literature review. Klinicheskaya onkogematologiya 2014; 7(3): 264–277. (in Russ.)

10. Besson C., Goubar A., Gabarre J., Rozenbaum W., Pialoux G., Châtelet F.P. et al. Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy. Blood 2001; 98: 2339–2344. DOI: 10.1182/blood.v98.8.2339