title: Durable survival after chemotherapy in a HIV patient with Burkitt's lymphoma presenting with massive upper gastrointestinal bleeding.
abstract: Massive upper gastrointestinal bleeding is an uncommon presentation of Burkitt's lymphoma in a patient with HIV/AIDS, and is seldom reported in the literature. A 39-year-old man who has sex with men presented with abdominal pain and massive haematemesis and a rapid drop in haemoglobin level to 4.8 g/dL. Upper gastrointestinal endoscopy showed a large blood clot in the stomach, and an emergency laparotomy was performed because of unstable haemodynamics. This showed active bleeding from multiple tumours in the fundus and body of the stomach. The patient underwent gastrectomy and gastric biopsy confirmed Burkitt's lymphoma. Further tests showed lymphoma involvement in bone marrow and central nervous system. The patient tested positive for HIV, and had a CD4 count of 212 cells/mm(3) and viral load of 18,000 copies/mL at diagnosis. He was commenced on a chemotherapy regimen of CODOX-M/IVAC, and highly active antiretroviral therapy consisting of indinavir, stavudine and lamivudine. The major side effect was peripheral neuropathy. Infective complications during chemotherapy were controlled by broad-spectrum antibiotics and anti-fungal agents. Complete remission of the lymphoma was achieved after the chemotherapy and remission was maintained for more than 14 years.
authors.affiliation: Department of Medicine, Tuen Mun Hospital, Hong Kong Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong mflaw99@yahoo.com.hk.
authors.forename: Man F
authors.initials: MF
authors.lastname: Law
authors.affiliation: Department of Medicine, Tuen Mun Hospital, Hong Kong.
authors.forename: Hay N
authors.initials: HN
authors.lastname: Chan
authors.affiliation: Department of Pathology, North District Hospital, Hong Kong.
authors.forename: Chun Y
authors.initials: CY
authors.lastname: Pang
authors.affiliation: Department of Medicine, Tuen Mun Hospital, Hong Kong.
authors.forename: Ho K
authors.initials: HK
authors.lastname: Lai
authors.affiliation: Department of Medicine, Tuen Mun Hospital, Hong Kong.
authors.forename: Chung Y
authors.initials: CY
authors.lastname: Ha
authors.affiliation: Department of Medicine, Tuen Mun Hospital, Hong Kong.
authors.forename: Celia
authors.initials: C
authors.lastname: Ng
authors.affiliation: Department of Medicine, North District Hospital, Hong Kong.
authors.forename: Rita
authors.initials: R
authors.lastname: Ho
authors.affiliation: Department of Radiology, Tuen Mun Hospital, Hong Kong.
authors.forename: Cheuk K
authors.initials: CK
authors.lastname: Wong
authors.affiliation: Department of Medicine, Tuen Mun Hospital, Hong Kong.
authors.forename: Yiu M
authors.initials: YM
authors.lastname: Yeung
authors.affiliation: Department of Medicine, Tuen Mun Hospital, Hong Kong.
authors.forename: Sze F
authors.initials: SF
authors.lastname: Yip
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001706:Biopsy; D002051:Burkitt Lymphoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D005743:Gastrectomy; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D018451:Homosexuality, Male; D006801:Humans; D007813:Laparotomy; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D008727:Methotrexate
keywords: AIDS; Burkitt’s lymphoma; HIV; haematemesis; massive gastrointestinal bleeding