Abstract
BackgroundMost malignant lymphomas in HIV-patients are caused by reactivation of EBV-infection. Some lymphomas have a very rapid fulminant course. HHV-8 has also been reported to be a cause of lymphoma. The role of CMV in the development of lymphoma is not clear, though both CMV and HHV-8 have been reported in tissues adjacent to the tumour in Burkitt lymphoma patients. Here we present a patient with asymptomatic HIV infection, that contracted a primary cytomegalovirus (CMV) infection and human herpes virus 8 (HHV-8) infection. Three weeks before onset of symptoms the patient had unprotected sex which could be possible source of his CMV and also HHV-8 infection He deteriorated rapidly and died with a generalized anaplastic large cell lymphoma (ALCL).MethodsA Caucasian homosexual male with asymptomatic human immunodeficiency virus (HIV) infection contracted a primary cytomegalovirus (CMV) infection and human herpes virus 8 (HHV-8) infection. He deteriorated rapidly and died with a generalized anaplastic large cell lymphoma (ALCL). Clinical and laboratory records were compiled. Immunohistochemistry was performed on lymphoid tissues, a liver biopsy, a bone marrow aspirate and the spleen during the illness and at autopsy. Serology and PCR for HIV, CMV, EBV, HHV-1–3 and 6–8 was performed on blood drawn during the course of disease.ResultsThe patient presented with an acute primary CMV infection. Biopsies taken 2 weeks before death showed a small focus of ALCL in one lymph node of the neck. Autopsy demonstrated a massive infiltration of ALCL in lymph nodes, liver, spleen and bone marrow. Blood samples confirmed primary CMV- infection, a HHV-8 infection together with reactivation of Epstein- Barr-virus (EBV).ConclusionPrimary CMV-infection and concomitant HHV-8 infection correlated with reactivation of EBV. We propose that these two viruses influenced the development and progression of the lymphoma. Quantitative PCR blood analysis for EBV, CMV and HHV-8 could be valuable in diagnosis and treatment of this type of very rapidly developing lymphoma. It is also a reminder of the importance of prevention and prophylaxis of several infections by having protected sex.
Highlights
Most malignant lymphomas in human immunodeficiency virus (HIV)-patients are caused by reactivation of EBV-infection
As the majority of HIV-infected patients are CMV-seropositive at the time of seroconversion little is known about primary CMV infection in HIV-patients with or without severe immunodeficiency
Clinical report A 34-year old HIV-infected man presented acutely due to a 2 days’ period of fatigue and fever. Two years earlier he had been diagnosed with HIV-infection as a result of screening for sexually transmitted infections (STI)
Summary
Most malignant lymphomas in HIV-patients are caused by reactivation of EBV-infection. The first case was a pregnant HIV positive woman on antiretroviral therapy, who was diagnosed with primary CMV-infection after 30 weeks gestation She was treated with intravenous ganciclovir iv for a week and thereafter valacyclovir orally until the end of pregnancy. The authors conclude that the overlapping manifestations of acute HIV-1 and CMV makes it difficult to determine how each virus infection contributed to his condition None of these primary CMV-infection cases were associated with lymphoma or other tumour development. A malignant lymphoma in an HIV-positive patient with EBV and HHV-8 co infection has recently been described by Crane et al [9]. Two cases of fatal disseminated Kaposi’s sarcoma following HHV-8 primary infections has been described by Marcelin et al [14] They died at 5 and 6 months after transplantation after a disease course of 3 to 4 weeks. All viruses were detected by immunohistochemistry and they suggest that these viruses might be a contributing factor to lymphoma development
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