Human herpes virus 8-unrelated primary effusion lymphoma-like lymphoma in a patient with hepatitis B virus-related liver cirrhosis: A case report
A 66-year-old male patient developed a rapid progressive abdominal fullness for 3 months. He had 30-year history of chronic HBV infection without family history of lymphoma and hepatitis. Three years before his hospitalization, liver cirrhosis was diagnosed through clinical, ultrasonography, and biochemical examinations. Physical inspection revealed a distended abdomen with shifting dullness. The liver and spleen were impalpable. The laboratory tests revealed impaired renal function (creatinine: 3.0 mg/dL), mild hypoalbuminemia (3.3 g/dL) and an elevated lactate dehydrogenase (LDH) serum level (750 U/L), while the liver biochemistry profile, including aminotransferases, bilirubin, and prothrombin time, were normal. Serological tests were found negative for HIV, Hepatitis C Virus (HCV) and Cytomegalovirus (CMV). Abdominal sonography confirmed the presence of cirrhosis, massive ascites, and pleural effusion. Cytological analysis of the pleural effusion demonstrated the presence of large atypical lymphoid cells with rounded nuclei, prominent nucleoli and abundant cytoplasm []. Immunocytochemistry recognized atypical CD20+ lymphoid cells []. The cells contained in the pleural fluid were negative for HHV-8 and Epstein-Barr virus (EBV). Additionally, no evidence of lymph nodes or organ involvement was found. A comprehensive treatment strategy including diuresis, antiviral therapy, prevention of infection and maintenance of vital organ function, was adopted. The patient died on the 7th day after his hospitalization due to sepsis and multi-organ failure.