AIDS-Related Lymphomas Clinical Presentation

Updated: Dec 22, 2022
  • Author: Christina Poh, MD; Chief Editor: Emmanuel C Besa, MD  more...
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History and Physical

Presenting symptoms and signs of AIDS-related lymphomas depend on the site of involvement, which can be variable. Common clinical manifestations include lymphadenopathy, organomegaly, and/or constitutional B symptoms. Patients can also present with unexplained cytopenias.

Of note, manifestations of primary central nervous system (CNS) lymphoma can include altered mental status, headache, blurred vision, and cranial neuropathies although these symptoms can also occur with CNS involvement from systemic lymphoma. [25]  Patients with primary effusion lymphoma can present with pleural or pericardial effusions.

Patients with AIDS-related lymphoma are more likely to present with the following, compared with HIV-negative lymphoma patients: [26]

  • Advanced-stage disease
  • Constitutional B symptoms (fever, night sweats, weight loss > 10% over 6 months)
  • Extranodal involvement (GI tract, liver, lung, pleura, CNS, bone marrow)
  • Disease involving uncommon locations (body cavity, soft tissue)

Oral lesions are second in frequency (11–33%) after gastrointestinal symptoms. These lesions are not similar to an ulcer or plaque, and most commonly appear as a rapidly growing mass on the palate or gingiva. [27]

Because AIDS-related lymphoma is generally associated with aggressive lymphoma histologies, advanced-stage disease, and extranodal involvement, patients may experience oncologic emergencies such as tumor lysis syndrome (hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia), and acute organ dysfunction (cardiac tamponade or GI, biliary, or ureteral obstruction).

Although lymphomas may appear at any time during the course of HIV infection, certain emergence patterns have been noted, depending on histologic subtype. Diffuse large B-cell lymphoma (DLBCL) and primary CNS lymphoma tend to occur during CD4 count nadir. In contrast, Burkitt lymphoma generally occurs when CD4 counts are better preserved. Hodgkin lymphoma occurrence has been seen during the first few months of antiretroviral therapy, when CD4 counts are improving. [28]