Four Cases of Non-Hodgkin's Lymphoma in AIDS patients
A 38-year-old male with AIDS presented with a palpable mass he'd had for 5 months in the left cervical region. HIV infection was possibly through heterosexual contact and he was diagnosed two years earlier, but no particular treatments were established before admission. On physical examination, 0.8 cm-sized lymph nodes were palpable in the left cervical areas. The heart and lungs were normal, and the chest X-ray was normal. A CT scan of the head and neck () showed enlarged left sided cervical lymph nodes that measured 1.6 cm × 2.4 cm in diameter. Excisional biopsy of a cervical lymph node was performed, and the histologic study suggested diffuse large B-cell lymphoma (). Immunohistochemical staining showed the atypical cells to be CD20 positive (). On admission, the patient did not declare any discomfort and the physical examination was normal. The laboratory finding were as follows; hemoglobin 14.4 g/dL, WBC 5,310/mm3 (neutrophils: 55.9%, lymphocytes: 39% and monocytes: 4.1%), platelet 178,000/mm3, ESR 9 mm/h, AST 39 IU/L, ALT 32 IU/L, total bilirubin 1.5 mg/dL, LDH 378 IU/L, protein 7.9 g/dL, albumin 4.0 g/dL, BUN 15.9 mg/dL, creatinine 0.88 mg/dL, calcium 8.5 mg/dL, phosphorus 4.2 mg/dL, Na 137 mmol/L, K 4.5 mmol/L, the percent of the CD4 and CD8 T lymphocytes was 20.5% and 70% of the total lymphocyte count, respectively, and the total number of CD4 cells was 420/mm3. The CD4/CD8 ratio was 0.36. He was treated via immunochemotherapy with Rituximab and CHOP for six cycles. After 5 cycle of R-CHOP, the CD4 cell count decreased from 420 to 95/mm3 and a regimen of zidovudine, lamivudine and didanosine were used as HAART. After 6 cycles of R-CHOP, the follow-up CT revealed marked regression in the size of the lymph nodes at both internal jugular channels (). He is currently under follow-up for the lymphoma.