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Program

Internal Medicine

Training Level

Resident PGY 1

Institution

Henry Ford Macomb

Abstract

Background: Primary effusion lymphoma, a subtype of Non-Hodgkin’s lymphoma, is linked with HHV-8. This disease is associated with immunocompromised patients such as those who have HIV, solid organ transplant carriers, or chronic hepatitis C. Primary effusion lymphoma frequently commences in the pleura, pericardium, and peritoneum. Case: A 77 year old middle eastern male with history of tobacco usage was admitted for fatigue and hypotension. Chest x-ray revealed bilateral pleural effusions. He had received a diagnostic and therapeutic thoracentesis. Cytology revealed that it was positive for HHV-8, a diagnostic criteria for primary effusion lymphoma. The patient was tested for HIV, HTLV, and hepatitis B/C. The testing was negative. The patient later revealed that he had Kaposi sarcoma a year prior to presentation on his right leg that was removed by his dermatologist. After having multiple thoracenteses, the patient later had a pleurex catheter placed. Given the patient’s other heart comorbidities, he was evaluated by oncology, and they had recommended a more palliative approach. Conclusion: This was a rather unusual diagnosis in an ailment that typically is associated with HIV. The first line treatment for primary effusion lymphoma is cyclophosphamide, doxorubicin, etoposide, vincristine, and prednisone along with HAART in those who are HIV positive. The therapy is less clear for those who are HIV negative due to being an extremely rare patient population. There has been less than 30 cases described in this subset population and they have typically been elderly, Mediterranean males. They key diagnostic criteria in diagnosing primary effusion lymphoma is the expression of HHV-8 in the malignant cells. Prognosis remains poor despite the use of chemotherapy; median survival is 6 months.

Publication Date

5-2019

Primary Effusion Lymphoma in an HIV negative male with history of Kaposi Sarcoma

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