Internal Medicine Kettering Health Dayton Dayton, Ohio, United States
Clinical Scenario or Case: A 43 year old woman presented to the hospital due to diffuse, tender subcutaneous nodules on her abdomen, lower back and left leg. She has a known history of HIV and was on Biktarvy and Bactrim, her last known CD4 count was 156. CT imaging showed numerous soft tissues masses throughout the chest wall, lungs,and breasts. Biopsy of one of the lesions demonstrated aggressive lymphoma with plasmacytic differentiation, which is consistent with plasmablastic lymphoma. The patient was ultimately started on a chemotherapy regimen of etoposide, vincristine and doxorubicin with bolus cyclophosphamide and prednisone (EPOCH) plus daratumumab (1,2)
Evidence/Literature Review: Plasmablastic lymphoma is a rare lymphoma that is estimated to account for only 2% of all HIV-associated lymphomas. It typically presents as an extranodal manifestation in the oral cavity/jaw of HIV positive patients (1).
Unique Aspects of Case: In this case, the patient presented with an atypical presentation of the disease. Only 6% of plasmablastic lymphomas present with skin lesions (1,3).
Recommendations/Conclusions: Due to its rarity, many physicians are likely unfamiliar with this disease. This case allows for increased awareness of typical and atypical presentations of the disease. Additionally, it also highlights the current recommended treatments.
