Primary Gastric Plasmablastic Lymphoma Following Antiretroviral Therapy Interruption in a Patient With Previously Treated Gastric Diffuse Large B-cell Lymphoma: a Refractory Case Report
Year: 2026
Type: article
Study design: Case Report
Abstract: Introduction Plasmablastic lymphoma (PBL) is a rare and highly aggressive HIV-associated lymphoma characterized by plasmacytic differentiation, a high proliferative index, and poor prognosis. Although extranodal involvement is common, primary gastric disease is uncommon and remains therapeutically challenging. Case report A 39-year-old man living with HIV presented with severe abdominal pain, melena, and a 15-kg weight loss after interrupting antiretroviral therapy (ART) for three months. His HIV viral load was 3.4 million copies/mL. He had a history of stage IVB primary gastric diffuse large B-cell lymphoma (DLBCL, CD20-positive) diagnosed in 2010, successfully treated with CHOP chemotherapy and radiotherapy, achieving complete remission for approximately 14 years. Upper gastrointestinal endoscopy revealed a large infiltrative gastric ulcer. Histopathology demonstrated a high-grade lymphoma expressing CD138, CD10, PAX5, and BCL2, with Ki-67 ≈99% and negativity for CD20, CD3, and cytokeratin, confirming plasmablastic lymphoma. PET/CT demonstrated diffuse gastric involvement (SUVmax 46.9), abdominal lymphadenopathy, peritoneal implants, and invasion of adjacent organs. The patient received dose-adjusted EPOCH followed by DHAP and GemOx because of progressive disease, without clinical response. During treatment, he developed esophageal candidiasis, herpes zoster, upper gastrointestinal bleeding, pleural effusion, and invasive candidemia. Owing to refractory disease and progressive clinical deterioration, palliative care was instituted. The patient died from septic shock secondary to invasive candidemia. Conclusion This case highlights the aggressive biological behavior of HIV-associated primary gastric plasmablastic lymphoma and its rapid progression following ART interruption. The prolonged remission of a previous gastric DLBCL, followed by the development of a distinct refractory lymphoma, emphasizes the complexity of lymphoid neoplasms in immunosuppressed patients. Despite intensive sequential chemotherapy, no meaningful response was achieved, underscoring the limited efficacy of current treatment strategies. Early HIV control, prompt recognition of extranodal disease, and the development of novel molecularly targeted and immunotherapeutic approaches are essential to improve outcomes in this rare and highly lethal lymphoma. This study received no financial support.
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223099099