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Rare Extraoral Plasmablastic Lymphoma in the Context of HIV and Toxoplasmosis: A Detailed Case Analysis With Therapeutic Insights

Year: 2025

Type: article

Abstract: ABSTRACT Plasmablastic lymphoma (PBL), a rare aggressive B‐cell malignancy linked to HIV, is increasingly noted in extraoral sites beyond its traditional oral cavity presentation. This case report details a 48‐year‐old HIV‐positive woman with prior cerebral toxoplasmosis, presenting with facial swelling, pain, proptosis, and dysphagia despite antiretroviral therapy and cotrimoxazole prophylaxis (CD4 120 cells/μL, suboptimal viral suppression). Imaging identified a sinonasal mass with nasopharyngeal involvement and lymphadenopathy, with immunohistochemistry confirming PBL (MUM1+, weakly CD79a+, CD20‐, CD138‐, EBER‐). Treatment comprised six cycles of dose‐adjusted EPOCH with bortezomib (1.3 mg/m 2 on days 1, 8, 15), intrathecal prophylaxis, and supportive care for recurrent neutropenia, achieving a complete metabolic response on interim FDG‐PET/CT after three cycles, with follow‐up CT showing pansinusitis. The patient is now eligible for autologous stem cell transplantation and consolidative radiotherapy, highlighting the diagnostic complexity of CD138‐negative extraoral PBL and the efficacy of bortezomib‐augmented EPOCH in this high‐risk case.

Source: Clinical Case Reports

DOI: 10.1002/ccr3.71253

Authors: Nima Alishavandi, Mehrzad Kaviani, Seyyed Taher Seyyed Mahmoudi, Mahmoudi Masoud Mortezazadeh, Samira Farahmand, Tahere Yousefi