Simultaneous Presentation of Relapsed Diffuse Large B-cell Lymphoma and Extrapulmonary Tuberculosis in a Patient With...

Area of Science:

• Infectious Disease
• Oncology
• Immunology

Background:

• Human immunodeficiency virus (HIV) infection is a known risk factor for opportunistic infections and certain malignancies, including diffuse large B-cell lymphoma (DLBCL).
• Both DLBCL and tuberculosis (TB) can present with overlapping clinical symptoms, posing significant diagnostic and therapeutic challenges, particularly in HIV-infected individuals.

Observation:

• This report details a unique case of an HIV-infected patient presenting concurrently with relapsed DLBCL involving the spinal cord and mesenteric lymph node tuberculosis.
• The simultaneous occurrence of these two distinct conditions underscores the complexity of managing coinfections and malignancies in immunocompromised patients.

Findings:

• The case highlights the potential for multiple, concurrent diagnoses in individuals with HIV, necessitating a high index of suspicion and prompt diagnostic confirmation.
• Interferon-gamma release assays (IGRAs) demonstrated low sensitivity for detecting tuberculosis in this HIV-positive patient.
• Maintaining adherence to antiretroviral therapy (ART) is critical for achieving and sustaining remission in DLBCL patients.

Implications:

• Clinicians should maintain a low threshold for obtaining biopsies to confirm diagnoses in HIV-infected patients with complex presentations.
• Diagnostic strategies for tuberculosis in HIV-positive individuals may require complementary approaches beyond IGRA due to potential low sensitivity.
• Effective management of HIV through ART is fundamental for controlling both opportunistic infections and HIV-associated lymphomas like DLBCL.