Plasmablastic lymphoma in a previously undiagnosed human immunodeficiency virus-positive patient: a case report

PBL is extremely aggressive and has a poor response to treatment.5 Plasmablastic lymphoma often affects middle-aged people but may also occur in the pediatric population.6 Classic triad of symptoms including fever, weight loss, and night sweats are usually present in PBL whereas lymphadenopathy is not among the common symptoms.7 Clinically PBL may resemble periodontal disease, Kaposi sarcoma, or melanoma.6 Even though PBL is difficult to diagnose and distinguish from myeloma or other types of lymphomas, a biopsy is essential in the diagnosis.7 Delayed diagnosis adversely affects the treatment and life expectancy.3 Patients who reject any treatment have a median survival of three months after their diagnosis.8 This case report aims to emphasize the paramount role of biopsy, early clinical suspicion, and correct diagnosis. [...]the patient was advised to take an enzyme-linked immunosorbent assay due to the high possibility of an HIV-infection. A co-infection of Epstein-Barr Virus (EBV) intensifies its aggressive nature.9 The prognosis of PBL is very poor without any treatment and life expectancy is between 1 -24 months.6 The difference in prognosis between HIV-negative and positive patients is uncertain.11 PBL has a male predominance of 75%, which also coincides with our case. Currently, there are no standard guidelines for PBL treatment, instead there are different chemotherapeutic options, most of which include the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone, or the combination of etoposide, prednisone, vincristine, cyclophosphamide and hydroxydaunorubicin, shortly known as CHOP and EPOCH, respectively.13 Autologous or allogeneic hematopoietic stem cell transplantation is another option for PBL; however, its benefit is unclear and is generally used as a consolidation or salvage therapy.15 Several reports claim that autologous hematopoietic stem cell transplantation after the first complete response results in improved remission in PBL and treatment reinforcement in refractory or relapsed PBL patients.16 The literature is supportive of the use of EPOCH, followed by autologous hematopoietic stem cell transplant in eligible patients, due to its better outcomes than CHOP.17 A similar treatment plan was followed for the present case, as well.