Cardiac mass in a patient with HIV infection: A case report and literature review

Hematological malignancies have multiple complications depending on their type and treatment, ranging from thromboembolic events to myocardial infarction and cardiac metastases. Cardiac masses can be benign or malignant (primary or secondary). When diagnosed, malignant cardiac tumors are usually metastatic in nature and are observed in patients with advanced neoplasia or disseminated disease. Depending on the subgroup of patients, some hematological malignancies have a higher incidence compared with the general population, such as patients living with HIV infection (PLWHIV). In this subgroup of patients, lymphomas, mainly the non-Hodgkin lymphoma subtypes, including large B-cell lymphoma and Burkitt lymphoma (BL), are the most frequent malignant tumors identified. These tumors may occur even in PLWHIV with a normal CD4⁺ cell count and are highly aggressive tumors that, even though not frequently, may lead to cardiac metastases, highlighting the need for a high degree of suspicion, rapid diagnosis and treatment initiation in these patients. The present study encompasses a literature review on cardiac BL and a representative case of a 57-year-old man with a history of HIV infection, with a preserved CD4⁺ cell count, who was diagnosed with BL with secondary cardiac involvement. The rapid growth of the tumor was outlined in sequential echocardiographic evaluations and a multi-agent chemotherapy regimen was initiated. The treatment was well tolerated, with a notable reduction in the cardiac mass and no cardiovascular complications associated with treatment during monitoring of the patient. A literature review was conducted to identify all the documented cases of adult cardiac BL of the past 15 years, outlining the low prevalence and high risk of these lymphoid tumors and main diagnostic methods, highlighting the importance of early imaging and multidisciplinary management of these rare but life-threatening cases.