An Unusual Presentation of Nodular Lymphocyte-Predominant Hodgkin Lymphoma While on Antiretroviral Therapy: A Case Report

Background: Recent reports have shown an increased incidence of Hodgkin lymphoma (HL) in patients treated with antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection. This report is of a case of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) with a good outcome in a 58-year-old HIV-positive man who was on ART.

Case presentation: A 58-year-old HIV positive male presented to clinic for evaluation for mass in the left axilla region for several years. He was diagnosed with HIV in 2005 and well-controlled on ART. Physical examination was remarkable for tender left anterior axillary lymphadenopathy. Laboratory workup were within normal limits. CD4 count was 1262 cells/L and viral load was undetectable. He underwent computed tomography (CT) scan of chest and neck which showed left axillary adenopathy as well as staging Positron emission tomography-computed tomography (PET/CT) that showed focal uptake in two left axillary lymph nodes. He underwent excision of the primary left axillary lymph node. Histopathology showed nodular replacement of normal architecture with histiocytes, lymphocytes, and typical lymphocyte-predominant (LP) cells, which expressed BCL-6, CD-20, and EMA, consistent with a diagnosis of NLPHL. Patient had site radiation therapy and had a 5-month follow-up PET/CT scan which showed no evidence of malignancy.

Conclusion: This report presents a case of HIV-associated NLHPL that had an indolent course and good treatment outcome. This case highlights the importance of regular physical examination in HIV patients while on treatment with ART and accurate diagnosis of the cause of lymphadenopathy to prevent extra-nodal spread in cases of lymphoma.