Primary hepatic Burkitt's lymphoma as first manifestation of HIV-AIDS in a hepatitis B seropositive adult: when defences fail

Description

A previously well 32-year-old heterosexual man presented with progressive wasting syndrome, jaundice, night sweats, vomiting and abdominal pain for 1 month. There was no history of recreational drug use or exposure to hepatotoxins. Examination showed normal vital signs, a body mass index of 18 kg/m², generalised muscle atrophy, oral thrush and no lymphadenopathy with an enlarged liver 14 cm below the costal margin at the midclavicular line. The physical examination was otherwise normal.

Serology for HIV enzyme-linked immune sorbent assay (ELISA), Western blot immunoassay tests and hepatitis B surface antigen were all seropositive confirming new onset HIV–AIDS with hepatitis B coinfection. Extensive investigations for other diseases were negative and relevant results are shown (table 1). The HIV viral load was high at 300 392 RNA copies/mL and the CD4+ T-cell count was low at 116 cells/µL (reference values 410–1590). Serum creatinine was also high at 4.2 mg/dL and blood urea...

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