Four Cases of Non-Hodgkin's Lymphoma in AIDS patients
A 37-year-old male was admitted to our hospital because of his left sided hemiplegia that he had experienced for 3 months. He was known to be positive for HIV, as was determined during evaluation for idiopathic thrombocytopenic purpura in a foreign country about 6.5 years before this admission. At that time, he had been treated with zidovudine, lamivudine and saquinavir for the management of AIDS for 9 months and then he discontinued therapy of his own will. He was advised to restart treatment with zidovudine, lamivudine and indinavir at our hospital 4 years ago. He noticed weakness on the left side of his body during movement, which had slowly progressed and he finally developed left-sided hemiplegia 3 months previously. At the time of admission, he had complaints of headache and night sweats. He was diagnosed as having idiopathic thrombocytopenic purpura about 6.5 years ago and so splenectomy was done. Even after splenectomy, the thrombocytopenia continued. He was treated with steroid, vincristine, intravenous gammaglobulin, rituximab and danazole. He had also experienced liver abscess 4 years ago. He had received radiation for Kaposi sarcoma about 8 months before admission. On admission, the blood pressure was 90/60 mmHg, the pulse rate 100/min, the respiration rate 22/min and the body temperature was 38℃. Upon physical examination, the patient was in poor general condition with anemic conjunctiva. There were no signs of hemorrhagic diathesis or icterus. The laboratory finding were as follows; hemoglobin 7.4 g/dL, WBC 8,300/mm3 (neutrophila: 79.5%, lymphocytes: 14.6%, monocytes: 4.6%), platelets 10,000/mm3, erythrocyte sedimentation rate (ESR) 2 mm/h, AST 24 IU/L, ALT 9 IU/L, total bilirubin 0.7 mg/dL, LDH 473 IU/L, protein 3.9 g/dL, albumin 2.3 g/dL, BUN 9.5 mg/dL, creatinine 0.42 mg/dL, calcium 7.3 mg/dL, phosphorus 3.1 mg/dL, Na 130 mmol/L, K 3.0 mmol/L, the total number of CD4 and CD8 T lymphocytes was 46/mm3 and 621/mm3, respectively, and the ratio of CD4/CD8 was 0.07. The chest X-ray was not remarkable. Brain MRI () shows 4 cm-sized round mass involving the right frontal lobe. The T1 weighted image and the T2 weighted image () showed extensive areas of perilesional edema involving the right frontoparietal region and there was a mass effect upon the right lateral ventricle. Stereotactic biopsy of the brain lesion was performed, and histological examination disclosed atypical lymphoid cells with a predominant perivascular arrangement (). Immunohistochemical examination showed positivity for CD20. The diagnosis of diffuse large B-cell lymphoma involving the CNS was made. The patient was treated with brain radiation. Sadly, he died of pneumonia 13 days after brain radiation therapy.