AIDS-related lymphoma in a young HIV late presenter patient

Non-Hodgkin's lymphoma (NHL) is an acquired immunodeficiency syndrome (AIDS)-indicative disease. Nowadays, NHL is rarely reported in Europe as indicative disease for human immunodeficiency virus (HIV) testing. We present the case of a 22-year-old Romanian male patient without past medical history, except the swelling of a submental lymph node 11 months ago. The excised node was histologically examined but the patient neglected to take his result. He was admitted for fever, asthenia, and weight loss over 10% of his weight, and night sweats in the last four months. The immunohistochemical analysis of the preserved lymph node samples suggested reactive hyperplasic lymphadenitis with suppuration and necrosis (lymphoid follicles CD20+, CD10+, BCL6+; germinal centers CD23+, CD68+, Ki67+; and interfollicular CD3+). Clinical, biological and imaging evaluations were performed. The diagnostic of lymphoma stage IV Ann Arbor was sustained. Severe immunosuppression and a positive HIV test were found. The patient received antiretroviral treatment, but he developed paraplegia consecutive to a vertebral metastasis, liver and kidney failure and died sooner than two months from the diagnostic time. Pathological examination confirmed NHL with diffuse lymphocyte infiltrate of multiple organs. Advanced lymphoma is a rare indicator condition of HIV diagnostic. Delayed diagnostic of lymphoma implies ethical issues on communication deficiencies between the heath providers and patients, concerning the significance of biopsy. Infectious co-morbidities with necrosis and suppurative lesions are confounder conditions in NHL histological and immunohistochemical diagnosis.