SHM Converge Scientific Abstract ePoster Gallery-Burkitt Lymphoma in the Setting of Hiv With Undetectable Viral Load Case Study

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A 50-year-old man with HIV on effective treatment and an undetectable viral load presented with left eye blurriness, ptosis, mydriasis, and ophthalmoplegia. Initial imaging showed an infiltrative lesion in the cavernous sinus, raising concern for infection versus malignancy. He was treated empirically with broad-spectrum antibiotics and penicillin while undergoing an extensive workup, including lumbar puncture, MRI/MRV, spine MRI, PET scan, and infectious/inflammatory testing. Because symptoms persisted and imaging showed diffuse adenopathy and multisystem involvement, hematology was consulted and tissue biopsy was pursued. Pathology ultimately confirmed EBV-negative Burkitt lymphoma associated with HIV.<br /><br />The case highlights that HIV remains a significant cancer risk even when viral load is suppressed and CD4 counts are relatively preserved. Although untreated HIV is classically linked to AIDS-defining malignancies, patients with well-controlled HIV still have a substantially increased overall cancer incidence. The key teaching points are to evaluate vision changes urgently with early ophthalmology involvement and imaging, to pursue prompt biopsy when presumed infection is not improving as expected, and to maintain a low threshold for investigating atypical symptoms in people living with HIV.<br /><br />The patient was treated with EPOCH-R chemotherapy and follow-up PET imaging after two months showed remission.

Asset Subtitle

Philip Huang

Meta Tag

Author List Austin Carlen, Matthew Yoder, Philip Huang

Category Clinical Vignettes

Concept HIV

Concept Burkitt Lymphoma

Concept Neurologic Symptoms

Concept Visual Symptoms

Concept Medical Imaging

Distinguished Non-Finalist

Presenter Organization Ohio State University

Presenting Author Philip Huang

Track Adult

Keywords

HIV

Burkitt lymphoma

cavernous sinus lesion

ophthalmoplegia

ptosis

mydriasis

EBV-negative

biopsy

EPOCH-R chemotherapy

PET scan

HIV

Burkitt Lymphoma

Neurologic Symptoms

Visual Symptoms

Medical Imaging