Extracorporeal Membrane Oxygenation with rituximab‐combined chemotherapy in AIDS‐associated primary cardiac lymphoma: A case report

Abstract

Abstract Although effective combination of antiretroviral medications is being developed, the incidence of non‐Hodgkin lymphoma (NHL) with human immunodeficiency/acquired immunodeficiency syndrome (HIV/AIDS) still remains significantly higher than that in individuals without infection. Primary cardiac lymphoma (PCL) is an NHL that involves the heart and/or the pericardium. PCL is very rare and often causes serious complications, which can be a diagnostic challenge. To our knowledge, no study has reported the measurement of rituximab concentration under venoarterial extracorporeal membrane oxygenation (VA‐ECMO). Herein, we report the case of a 54‐year‐old male patient with AIDS‐associated primary cardiac NHL who developed right ventricular outflow tract obstruction. The patient experienced fatigue and dyspnea on exertion. Contrast‐enhanced computed tomography showed a bulky tumor mass in his right atrium and ventricle, and an echocardiogram revealed severe hypokinesis of his heart and poor cardiac output. A biopsy was performed, and immunohistochemistry revealed diffuse large B‐cell lymphoma. Therefore, he was treated with rituximab‐combined chemotherapy under VA‐ECMO. Blood levels of rituximab were measured during chemotherapy with VA‐ECMO. Thereafter, he was temporarily discharged from the hospital. This clinical case suggests that VA‐ECMO and rituximab‐combined chemotherapy are useful in rescuing patients with severe cardiopulmonary failure due to AIDS‐associated PCL.

Keywords

• acquired immune deficiency syndrome (AIDS)
• diffuse large B‐cell lymphoma (DLBCL)
• extracorporeal membrane oxygenation (ECMO)
• primary cardiac lymphoma (PCL)
• rituximab