Abstract Ref Number = APCP747
NON-HODGKIN LYMPHOMA IN A CHILD WITH HIV INFECTION
septina samsiati,Sri Mulatsih,Ida Safitri
Department of Child Health Faculty of Medicine Public Health and Nursing Universitas Gadjah mada Dr Sardjito General Hospital Yogyakarta Indonesia Division of Hematooncology, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah MadaDr Sardjito General Hospital, Yogyakarta, Indonesia Division of Infectious diseases and tropical pediatrics, Department of Child Health, Faculty of Medicine Public Health, and Nursing, Universitas Gadjah MadaDr Sardjito General Hospital, Yogyakarta, Indonesia
Background : Despite recent evidence showing combined antiretroviral therapy (cART) reduces the risk of developing cancer in HIV-infected children, they have an increased risk to get cancer due to a compromised immune system and an increased susceptibility to oncogenic viruses. Reliable data on the burden of cancer in HIV-infected children are warranted, especially in resource-limited countries with large burdens of HIV/AIDS. Kaposi Sarkoma and Non-Hodgkin’s lymphoma (NHL) are the most common malignancies among HIV infected children in developed countries. Though NHL also occur in children with well-preserved immune systems, the risk of developing NHL increases with the duration of low CD4 counts. Similar symptoms (e.g lymphadenopathy, hepatosplenomegaly), increase the risk of delayed diagnosis of NHL in a child with HIV disease.
Case Presentation Summary : We report a case of an eight year-old boy who had been treated with cART presented with fever and submandibular swelling. Ultrasound revealed a soft mass enlargement that was considered as lymphoma, a CT scan of thorax and abdomen also revealed multiple lymphoma in the right lung. Immunobloting IgG examination of Ebstein barr virus returned with a positive result. Result of fine needle aspiration supported to Non-Hodgkin lymphoma, and patient then started to have chemotherapy containing cyclophosphamide, doxorubicin and vincristine. There was a significant reduce in the size of the submandibular mass after chemotherapy. However, the risk of opportunistic infection arised. Series of laboratory investigations showed anemia, hypoalbuminemia, hyponatremia and hypomagnesemia. Despite adequate treatment, the patient passed away due to many coinfections. The patient completed four cycle of chemotherapy from the eight cycle planned to be given.
Learning Points/Discussion : The challenge in managing this case was related with the immunocompromised condition on a HIV patient receiving chemotherapy which was complicated with sepsis,opportunistic infection, and electrolyte abnormalities. Better data on cancer in HIV-infected children are required to improve the overall management in such cases
Keywords: Non-hodgkin lymphoma HIV-infection children