Aggressive extensive cardiac mass in an HIV-1-infected patient: should we go for comfort therapy?

Area of Science:

• Cardiology
• Oncology
• Infectious Diseases

Background:

• Cardiac masses are uncommon, with diverse etiologies including infections, neoplasms, and thrombi.
• Accurate diagnosis and therapeutic planning for cardiac masses necessitate pathology specimens, even with advanced imaging.
• HIV-1 infection can present with complex cardiac manifestations.

Observation:

• A 49-year-old male with HIV-1 presented with progressive edema, atrial fibrillation, and a giant cardiac mass involving both atria and surrounding tissues.
• The cardiac mass was deemed inoperable due to its extensive and invasive nature.
• Positron Emission Tomography-Computed Tomography (PET-CT) scan was used for staging.

Findings:

• The patient was diagnosed with stage IV Burkitt lymphoma with significant extranodal cardiac involvement.
• Initial treatment followed the GMALL B-NHL86 protocol, later modified to R-CHOP due to tolerance issues.
• The patient achieved complete remission with no evidence of relapse during follow-up.

Implications:

• This case highlights the importance of considering lymphoma in the differential diagnosis of cardiac masses, particularly in immunocompromised patients.
• Aggressive chemotherapy, even when modified, can be effective in treating advanced cardiac Burkitt lymphoma.
• Prompt diagnosis and tailored therapy are crucial for improving outcomes in rare cardiac malignancies.