CHEST Guidelines-A-32-Year-Old-Man-With-HIV-Infection,-Pleural-Effu

A-32-Year-Old-Man-With-HIV-Infection,-Pleural-Effu

Pdf Summary

A 32-year-old man with a decade-long history of HIV presented symptoms such as fever, nonproductive cough, diffuse lymphadenopathy, and polyarticular pain. Despite a critical CD4 count of 45 cells/mm³, he was not on antiretroviral therapy. His physical examination showed significant symptoms: a high fever, elevated heart and respiratory rates, and low blood oxygen levels. Laboratory tests confirmed severe abnormalities, including anemia, leukocytosis, thrombocytopenia, and elevated markers indicative of possible infection or inflammation, despite extensive initial infectious evaluations being negative.<br /><br />Chest CT scans highlighted bilateral pleural effusions, enlarged lymph nodes, and splenomegaly, with thoracentesis exhibiting atypical lymphocytes. The diagnostic evaluations suggested a rare condition: primary effusion lymphoma (PEL), a high-grade B-cell lymphoma associated with human herpesvirus-8 (HHV-8) and often Epstein-Barr virus (EBV), typically seen in individuals with HIV/AIDS. PEL is characterized by effusion presence in body cavities without solid tumors.<br /><br />The patient developed symptoms suggestive of hemophagocytic lymphohistiocytosis (HLH), characterized by heightened immune responses leading to systemic inflammatory presentations and multiorgan dysfunction. Despite empiric antibiotics and antiviral treatments, his condition deteriorated, highlighting the challenges of managing overlapping HIV-related conditions.<br /><br />PEL presents a poor prognosis but is generally managed using chemotherapy and combined antiretroviral therapy (cART), improving median survival to 6-10 months. HLH, likewise serious, requires prompt intervention with dexamethasone and etoposide. However, the complexity of co-occurring PEL and HLH demands a sophisticated and vigilant diagnostic approach, underscored by this case culminating in the patient's demise. The case emphasizes the diagnostic and therapeutic complexity of HIV-associated malignancies and the critical need for targeted, evidence-based treatment strategies.

Keywords

HIV

Primary Effusion Lymphoma

Hemophagocytic Lymphohistiocytosis

CD4 count

antiretroviral therapy

human herpesvirus-8

Epstein-Barr virus

chemotherapy

diagnostic challenges

HIV-associated malignancies