Spinal Compression Due to Burkitt Lymphoma in a Newly Diagnosed HIV-infected Child

Abstract

We describe a newly diagnosed HIV-infected child, without prior history of AIDS-defining disease, who presented with Burkitt lymphoma-related cauda equina syndrome that rapidly progressed to a flaccid paraplegia. Diagnosis was confirmed on biopsy and magnetic resonance imaging of the spine showed multiple epidural masses with involvement of several vertebral bodies, cord edema and compression of the cord and cauda equina. The child's immune status was relatively preserved and Epstein-Barr serology proved negative. Chemotherapy (LMB 89 modified protocol) was initiated immediately after histopathologic confirmation, together with highly active antiretroviral therapy. A follow-up magnetic resonance imaging 6 weeks later showed segmental cord atrophy at the site of previous edema despite complete resolution of all the epidural masses. Unfortunately, the child's neurologic state did not improve beyond the recovery of sphincter control and lower limb sensation. The patient is the first reported case of Burkitt lymphoma-related spinal cord compression as an initial AIDS-defining illness, in a 10-year-old child. The outcome of the case highlights the importance of early diagnosis and prompt treatment of this aggressive tumor to avoid permanent neurologic deficits.

Pyrites: A Mystifying Sacral Mass

“…[6][7][8] Selected reports of patients with ALCL with cauda equina syndrome or spinal cord compression among adolescents/young adults are summarized in Table 1. [9][10][11][12][13] Cauda equina syndrome secondary to malignancy is rare in children and is reportedly caused by neuroblastoma, 14 mature B-NHL, 15,16 chloroma, 17 Ewing sarcoma, [18][19][20] and spinal ependymoma. 21 The reported measures for nerve decompression include laminectomy, surgical debulking, radiotherapy, and chemotherapy.…”

Spinal cord compression by B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma in a patient seropositive for human immunodeficiency virus: a case report

“…Extranodal involvement of lymphoma commonly involves the gastrointestinal tract, bone marrow, liver, lung and central nervous system. Although survival from ARL has improved significantly with HAART [ 12 ], it is associated with high mortality rates when the epidural space is involved [ 13 ]. Epidural spinal cord compression occurs in 0.1 to 6.5% of patients with non-Hodgkin’s lymphoma (NHL) [ 14 - 16 ], either at the time of recurrence [ 17 ] or at the initial diagnosis [ 18 ].…”

Burkitt's lymphoma mimicking EBV disease as first sign of vertical HIV infection in an adolescent

“…In the developed countries NHL accounts for 65%-83% of AIDS-related malignancies, and BL rates about 40% of HIV-related NHL in children [17,18]. Hence, BL rarely represents the first sign of HIV infection in childhood whose HIV exposure status is not known [19]. Interestingly in this case, although the patient vertically acquired HIV infection, he had an asymptomatic neonatal period and childhood, with normal growth and development, up to 16 years old.…”