Extracavitary primary effusion lymphoma recurring with syphilis in an HIV-infected patient

• Published in: BMJ case reports Vol. 13; no. 11; p. e235204
• Main Authors: Sohail Ahmed, Darakhshan, Poliquin, Marc, Julien, Louis-André, Routy, Jean-Pierre
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 04.11.2020; BMJ Publishing Group
• Series: Case report
• Subjects: Antigens; Biopsy; Blood tests; Case reports; Chlamydia; Colorectal cancer; Constipation; Cytomegalovirus; Endoscopy; Fever; Gonorrhea; Herpes viruses; HIV; HIV Infections - complications; HIV Infections - diagnosis; Human immunodeficiency virus; Humans; Infections; Kaposis sarcoma; Lymph Nodes - pathology; Lymphatic system; Lymphoma; Lymphoma, Primary Effusion - complications; Lymphoma, Primary Effusion - diagnosis; Male; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Pain; Penis; Rectum - pathology; Sarcoma; Serology; Sexually transmitted diseases; STD; Syphilis; Syphilis - complications; Syphilis - diagnosis; Topography; Unusual Association of Diseases/Symptoms; syphilis; colon cancer; HIV / AIDS; infection (gastroenterology)
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-235204

A 59-year-old Caucasian man infected with HIV, in remission from human herpes virus-8-positive extracavitary primary effusion lymphoma (EC-PEL), presented to a sexual health clinic with fever and rectal pain 10 weeks after a single episode of receptive anal sexual intercourse with another man. He was initially treated for a presumptive diagnosis of lymphogranuloma venereum proctitis, then for syphilis on positive serology. Rectosigmoidoscopy revealed a single ulcerated rectal mass; endoscopic biopsies confirmed the recurrence of EC-PEL. The patient received chemotherapy and went into remission. This is the first reported case of EC-PEL occurring synchronously with early syphilis, and specifically at the site of inoculation, which can be a major diagnostic challenge since both conditions may present with lymphadenopathy, mucosal involvement and constitutional symptoms. We reviewed the literature for similar cases and hypothesised that syphilis may have triggered the recurrence of this rare lymphoma.