A Unique Case of Transient Spontaneous Regression Complicated with Tumor Lysis Syndrome of T-cell Lymphoblastic Lymphoma in HIV-Infected Patient without Antiretroviral Therapy
Pairaya Rujirojindakul MD*, Kanita Kayasut MD**, Montanan Rohitoprakarn MD***, Arnuparp Lekhakula MD*
Affiliation : * Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla ** Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla *** Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla
Spontaneous regression in high-grade non-Hodgkin lymphoma is rare. Herein, the authors report the case of a 26-year-old asymptomatic HIV-infected patient presenting with bleeding per gum after a dental extraction. Initially, a complete blood count showed lymphoblasts and thrombocytopenia. Laboratory inves- tigations were compatible with acute tumor lysis syndrome. Without any steroid or chemotherapy, both clini- cal and laboratory abnormalities were spontaneously returned to normal limits. However, three weeks later he developed generalized lymphadenopathy. A submandibular gland biopsy revealed to be T-cell lymphoblas- tic lymphoma. This was followed by the second episode of spontaneous tumor lysis syndrome and spontaneous regression of lymphadenopathy again. At this time, he was treated with cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) with whole brain irradiation. During seven months of chemotherapy, the physical examination and blood chemistry were normal. Unfortunately, after seven courses of CHOP, the disease rapidly progressed and ultimately lead to his death.
Keywords : Spontaneous regression, Tumor lysis syndrome, HIV, T-cell lymphoblastic lymphoma, carcino- matous meningitis
