HIV associated plasmablastic lymphoma
Materials and Methods/Case Presentation/Objective:
41 year old female who was diagnosed with HIV AIDS in July 2024, presented to the hospital in February 2025 with scattered painful subcutaneous skin nodules. On 2/18/2025, biopsy of abdominal wall nodule was consistent with PBL. CD138, CD79 positive. CD20 negative. Ki-67 >90%. PET/CT on 2/25/2025 shows widespread disease including extensive malignancy with dominant lesions in subcutaneous soft tissue throughout trunk and extremities. Multiple lesions along pleural surface of both lungs, lungs, mediastinum, left hilum, mesentery, multiple abdominal, retroperitoneal, pelvic lymph nodes, skin as well as liver and skeletal. Pt received LP with prophylactic intrathecal methotrexate. Pt was started on dose adjusted EPOCH+Velcade on 2/27/2025. After cycle 3, PET/CT on 5/14/2025 showed significant treatment response. Unfortunately after cycle 6, PET/CT on 8/7/2025 showed findings consistent with disease progression with Deauville 5. The patient required multiple hospitalizations for CMV viremia and pneumocystis pneumonia right after. CD4 count was persistently < 200 despite being on antiretroviral treatment. We started her on Pola-Gem-Ox as bridging chemotherapy before CART. Unfortunately after cycle 1 treatment, the patient ended up being hospitalized again and died from severe sepsis.
Results/Description/Main Outcome Measure(s):
Plasmablastic lymphoma is a subtype of diffuse large B-cell lymphoma that accounts for 2.6 % of AIDS related lymphomas. The usual presentation of PBL is around 40 years of age. Histopathology remains the gold standard for the diagnosis of PBL. Ki-67 > 60% correlates with the aggressive nature. It is crucial to control HIV related infections with appropriate antiretroviral therapy and prophylactic medications in order to avoid poor outcomes.
Conclusion(s).:
PBL in young people with HIV who have CD4+ counts < 200 cells/mm3 and chronic HIV infection can be catastrophic. Prognosis remains poor despite an initial good response to therapy.
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