HIV-associated B-cell lymphoma of a patient with multiresistant tuberculosis (clinical case)

Abstract

In the modern context, there is an increase in the detection of HIV/tuberculosis co-infection, which makes it difficult to timely diagnose and treat complications of HIV infection and, as a result, it is the cause of death. Today, it has been found that a high incidence of oncological diseases is a feature of HIV infection, and HIV infection is a risk factor for B-cell lymphoma development. The purpose of the work is to introduce the practitioners to the features of manifestation, diagnosis and course of HIV-associated B-cell lymphoma in a patient with multiresistant tuberculosis. Materials and methods. The article deals with a clinical case of our own observations of the multiresistant pulmonary tuberculosis (MRTB) progression in a patient with HIV-associated B-cell lymphoma. The patient underwent inpatient treatment in the Department of Pulmonary Tuberculosis No. 3 of the clinical base of the Phthisiology and Pulmonology Department of ZSMU (Zaporizhzhia State Medical University) in the Municipal Institution “Zaporizhzhia Regional TB Clinical Dispensary” (ZRTBCD), inpatient treatment in the Sophia Specialized Tuberculosis Hospital (SSTBH) № 55, branch of the “Health Center of Ukraine” in the Zaporizhzhia region. The results of our own observations. The patient was in a dispensary for HIV infection, chronic viral hepatitis B and C at an infectious disease specialist for 13 years. For all that, ART was not prescribed, since the patient refused it. Against the background of HIV infection, the patient developed retroperitoneal B-cell lymphoma, which was initially interpreted as tuberculosis of the retroperitoneal lymph nodes and was diagnosed only at autopsy. Additionally, pulmonary MRTB, chronic viral hepatitis B and C were occurred. Despite the effective antimycobacterial therapy for pulmonary MRTB, metastatic lesions of the lungs, liver, parietal and visceral pleura, abdominal lymph nodes, development of bilateral exudative pleurisy with a hemorrhagic component complicated the progressive course of oncologic disease. Given the situation, multiple organ failure developed and progressively increased with severe endogenous intoxication, which caused the death, due to the progressive course of cancer against the background of HIV infection with an extremely low number of CD4 lymphocytes (<100 cells/μl), as well as pulmonary MRTB. Conclusions. The lack of timely treatment of HIV infection (antiretroviral therapy) is associated with opportunistic diseases, severe complications development that occur in the guise of any other pathology, and consequently are extremely difficult to diagnose. The untimely lifetime diagnosis of retroperitoneal B-cell lymphoma in the described case resulted in a lack of chemotherapy, which caused the metastatic process development and death of the patient. Therefore, practitioners should always be aware of oncology, and be more vigilant with HIV-infected patients whose CD4 count of less than 100 cells/µl.

Keywords

• HIV
• lymphoma
• tuberculosis multi-drug resistant