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Abstract
AIDS related malignancies have gradually decreased after the introduction of highly active antiretroviral therapy (HAART). Nevertheless, non-Hodgkin's lymphoma is still a major malignancy in resource limited countries that have difficulty supplying HAART, and same holds true for Korea. We report a case of non-Hodgkin's lymphoma involving the heart in a Korean AIDS patient, who presented with sudden arrhythmia and superior vena cava syndrome. He was diagnosed with AIDS in 2008, but refused to receive HAART. Immunohistologic findings were compatible diffuse large B cell lymphoma, and futher studies demonstrated involvement of the liver, adrenal gland, heart, and pericardiac space. HAART was initiated and non Hodgkin's lymphoma was successfully managed with intensive chemotherapy. This is the first cardiac involvement non Hodgkin's lymphoma in AIDS patients in Korea.
Figures and Tables
Figure 1
(A) Chest CT scan taken on hospital day 1. Low attenuated lobulating mass in the right atrium with pericaridal effusion and left pleural effusion. (B) EKG taken hospital day 1. Sinus bradycardia 46 bpm with T wave inversion is seen in lead V1 to V3. (C) Echocardiograpy performed on hospital day 1. Mass (4.78 cm×2.55 cm) in the right atrium with pericardial effusion is observed.
Figure 2
(A) Diffuse sheet of atypical large lymphoid cells are observed in PAP smear mixed with small reactive lymphocytes. (B) Atypical large lymphoid cells show nuclear hyperchromatism and prominent nucleoli on the CD cell block specimen. (C),(D) Strong immunopositivity for CD20 and increased MIB-1 index by immunohistochemical study.
Figure 3
(A) EKG taken on hospital day 6 shows jucntional bradycardia with rate of 35 bpm, which was accompanied by dizziness. (B) Echocardiography performed on hospital day 6 revealed that the mass in right atrium has decreased from 4.78 cm×2.55 cm to 2.2 cm×1.5 cm after dexamethaxone treatment. (C) EKG taken on hospital day 22 demonstrates that the cardiac rhythm has normalized with its rate being 77 bpm. (D) Echocardiolgraphy performed on hospital day 22 shows that the right atrium mass has disappeared after the first EPOCH chemotherapy.
References
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