HIV+ patient presenting with primary effusion lymphoma
A 33‐year‐old man with a past medical history of HIV (non-compliant on antiretroviral treatment; CD4 <20, HIV RNA PCR: 164000) brought to the emergency department with symptoms of a cough, shortness of breath, and fever. He was hospitalized for further evaluation.

On physical examination finding, he appeared cachectic with tachycardia and jugular venous distention. Chest examination includes the presence of bibasilar crackles. Skin revealed the presence of scattered purple lesions on his chest.

A skin punch biopsy of the purple lesion was performed and sent to pathology for analysis using immunohistochemical stain revealed positive for HHV8. As part of his evaluation, he underwent echocardiogram that revealed pericardial effusion with findings concerning for pericardial tamponade requiring emergent pericardiocentesis. The pericardial fluid cytology revealed a diagnosis of primary effusion lymphoma (PEL).

CT chest indicated the presence of moderate‐sized bilateral pleural effusion (more on the right) requiring thoracocentesis. Pleural fluid cytology also confirmed findings consistent with PEL. He was started on first cycle of CHOP (Cyclophosphamide, Doxorubicin, Vincristine, Prednisone) in combination with antiretroviral therapy; however, unfortunately, despite our best efforts, patient decided to leave the hospital against medical advice.

Key takeaways:-
- Primary effusion lymphoma is considered a rare HIV‐related non‐Hodgkin ’s lymphoma (NHL) that constitutes for nearly 4% of all HIV‐related NHL.

- They have an increased tendency for arising within the body cavities (pleural space, pericardial, and peritoneum) is considered a unique clinical feature.

- It's presence reflects a dismal prognosis with an average survival time period of 6 months.

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