Epstein - Barr Virus (EBV) Associated B-Cell Lymphoma: An Unusual Involvement Of The Heart And Kidney In An HIV Positive Patient With Concurrent Cytomegalovirus (CMV) Pneumonia And Pneumocystis Jirovecii Pneumonia (PCP)

Abstract

Abstract Introduction/Objective We report a 68-year-old man with Human immunodeficiency virus (HIV) infection and significant weight loss during the past two years who presented with dyspnea. He was not receiving any treatment for HIV infection, and his viral load and CD4 count were 178000 copies/ml and 8 cells/mm3, respectively. The radiologic examination was concerning for Pneumocystis jirovecii pneumonia. The Bronchoalveolar lavage was positive for Pneumocystis jirovecii. The patient expired despite the comprehensive treatment, and the autopsy was requested. Methods The autopsy showed heavy lungs with diffuse consolidation and white discoloration involving all lobes. The left ventricular wall and right kidney cortex showed foci of white discoloration measuring 1 and 0.8 cm, respectively. Results The microscopic examination of lungs showed concurrent CMV pneumonia, and PCP confirmed by immunohistochemical staining for CMV and GMS special stain. The histologic evaluation of the heart and the right kidney and immunohistochemical staining for CD20 and CD3 in addition to in situ hybridization (ISH) for EBER revealed infiltrative malignant cells, which were positive for CD20 and EBER and negative for CD3. The EBV associated B-cell lymphoma involving the heart, and the right kidney was diagnosed Conclusion EBV is involved in human lymphomagenesis, particularly in HIV patients. There is a tendency for the lymphoma to involve the extranodal sites, including the CNS, gastrointestinal tract, liver, and bone marrow. However, the involvement of the heart and kidneys occurs very rarely. The autopsy findings of Lung co-infection with PCP and CMV and EBV associated lymphoma involving atypical locations is a rare and unique combination of AIDS-defining illnesses in this patient.