SHM Converge Scientific Abstract ePoster Gallery-A Case of a Rare Hiv-Related Lymphoma Misdiagnosed as Kaposi Sarcoma

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A 37-year-old man with advanced AIDS (CD4 count 43, later 30 cells/mm3) and no HAART presented with a rapidly enlarging left maxillary/oral mass that had been progressing for 6 months. He had previously been told the lesion was likely Kaposi sarcoma, but biopsy was delayed because of thrombocytopenia and he was lost to follow-up. On admission, labs showed mild pancytopenia and CT imaging demonstrated a rounded soft tissue mass with bony erosion concerning for malignancy.  <br /><br />Interventional radiology obtained a tissue biopsy, which showed an EBV-positive, ALK1-high-grade lymphoma with cMYC positivity, consistent with plasmablastic lymphoma (PBL). Immunohistochemistry was CD138 positive, MUM1 positive, CD20 and PAX5 negative, EBER positive, and cMYC positive. PBL is a rare, aggressive non-Hodgkin B-cell lymphoma that is most often associated with HIV and other immunocompromised states. Oral lesions in HIV patients have a broad differential, including Kaposi sarcoma, squamous cell carcinoma, lymphoma, HIV gingivitis, and oral hairy leukoplakia, and biopsy is usually required for diagnosis.  <br /><br />After diagnosis, the patient was transferred for chemotherapy and started on DA-EPOCH. HAART (Biktarvy) was initiated, along with opportunistic infection prophylaxis using atovaquone and azithromycin. He tolerated treatment well and was discharged with oncology and infectious disease follow-up. At 6 weeks, he had marked improvement and near-resolution of the facial lesion.  <br /><br />This case highlights how oral malignancies in patients with HIV can be misdiagnosed and delayed, emphasizing the importance of early biopsy, broad differential diagnosis, and coordinated hospitalist care to ensure timely treatment and follow-up.

Asset Subtitle

Jonathan Cunningham

Meta Tag

Author List Jonathan Cunningham, Maria Duran, Shacara Wilson

Category Clinical Vignettes

Concept Oral Mass

Concept Malignancy

Concept Plasmablastic Lymphoma

Concept Biopsy

Concept Diagnostic Workup

Distinguished Non-Finalist

Presenter Organization Orlando Health Bayfront Hospital Family Medicine Residency

Presenting Author Jonathan Cunningham

Track Adult

Keywords

AIDS

HIV

plasmablastic lymphoma

oral mass

maxillary lesion

EBV-positive

cMYC positivity

biopsy

DA-EPOCH

Kaposi sarcoma

Oral Mass

Malignancy

Plasmablastic Lymphoma

Biopsy

Diagnostic Workup