SHM Converge Scientific Abstract ePoster Gallery-Primary Effusion Lymphoma in a Patient With Hiv

Pdf Summary

This case describes a 43-year-old man with HIV and severe immunosuppression who presented with subacute cough and shortness of breath. He had previously achieved viral suppression on antiretroviral therapy but later stopped treatment because of financial barriers and was lost to follow-up. On admission, he was tachypneic but hemodynamically stable, with bilateral pleural effusions and widespread lung opacities on CT.<br /><br />Laboratory evaluation showed advanced HIV disease with a CD4 count of 39 and positive EBV PCR. Pleural fluid obtained by diagnostic/therapeutic thoracentesis was cloudy and exudative, with many atypical malignant-appearing cells. Bronchoscopy also revealed lesions consistent with Kaposi sarcoma, confirmed by shin biopsy, and bronchoalveolar lavage was positive for pneumocystis pneumonia. Cytology from the pleural fluid showed large pleomorphic lymphocytes positive for CD30, HHV8, and EBV, confirming primary effusion lymphoma (PEL). PET imaging demonstrated extensive FDG-avid disease in lymph nodes across the neck, chest, abdomen, and pelvis.<br /><br />The discussion highlights that PEL is a rare HIV-associated lymphoma, accounting for only 1–4% of HIV-related lymphomas. It is strongly linked to HHV8 infection and often also involves EBV. PEL typically arises in serosal cavities such as the pleura, pericardium, or peritoneum and presents as an exudative effusion containing abundant malignant cells. Prognosis is very poor, with survival often measured in months. Treatment generally includes antiretroviral therapy, chemotherapy, radiation, and antiviral therapy, ideally within a clinical trial.<br /><br />Overall, the case emphasizes the importance of recognizing PEL in immunocompromised patients with unexplained effusions and the need for rapid diagnosis and treatment planning.

Asset Subtitle

Patrick Throckmorton

Meta Tag

Author List Amy Sheldahl, Henry R. Kramer, Patrick Throckmorton

Category Clinical Vignettes

Concept Primary Effusion Lymphoma

Concept Human Herpesvirus 8

Concept HIV/AIDS

Concept Immunosuppression

Concept Pleural Effusion

Distinguished Non-Finalist

Presenter Organization University of Colorado Internal Medicine Residency Program

Presenting Author Patrick Throckmorton

Track Adult

Keywords

HIV

primary effusion lymphoma

HHV8

EBV

immunosuppression

pleural effusion

Kaposi sarcoma

pneumocystis pneumonia

CD30

exudative effusion

Primary Effusion Lymphoma

Human Herpesvirus 8

HIV/AIDS

Immunosuppression

Pleural Effusion