Durable survival after chemotherapy in a HIV patient with Burkitt’s lymphoma presenting with massive upper gastrointestinal bleeding

Abstract

Massive upper gastrointestinal bleeding is an uncommon presentation of Burkitt's lymphoma in a patient with HIV/AIDS, and is seldom reported in the literature. A 39-year-old man who has sex with men presented with abdominal pain and massive haematemesis and a rapid drop in haemoglobin level to 4.8 g/dL. Upper gastrointestinal endoscopy showed a large blood clot in the stomach, and an emergency laparotomy was performed because of unstable haemodynamics. This showed active bleeding from multiple tumours in the fundus and body of the stomach. The patient underwent gastrectomy and gastric biopsy confirmed Burkitt's lymphoma. Further tests showed lymphoma involvement in bone marrow and central nervous system. The patient tested positive for HIV, and had a CD4 count of 212 cells/mm(3) and viral load of 18,000 copies/mL at diagnosis. He was commenced on a chemotherapy regimen of CODOX-M/IVAC, and highly active antiretroviral therapy consisting of indinavir, stavudine and lamivudine. The major side effect was peripheral neuropathy. Infective complications during chemotherapy were controlled by broad-spectrum antibiotics and anti-fungal agents. Complete remission of the lymphoma was achieved after the chemotherapy and remission was maintained for more than 14 years.

Gastric Burkitt lymphoma

“…BL is a nodal or extranodal tumor that can be endemic (related on EBV or HIV-infection), sporadic and immunodeficiency-associated. [ 2 , 4 , 5 ] As regarding the sporadic BL, although the gastro-intestinal tract is the commonest site, hepatic BL was also reported to occur no later than 1 year after hepatitis B or C virus infection. [ 2 , 4 ] Helicobacter pylori infection, celiac disease, and post-transplant status were associated with extranodal lymphomas and even BL [ 6 , 7 ] but no papers about concurrent streptococcal infection-related cardiac disorders have been published to date.…”