Obstructive biliary symptomatology as the first sign of HIV-infection.

A 41-years-old white homosexual man presented with epigastric pain and jaun dice. Physical examination showed enlargement of bilateral axillar and left inguinal lymph node, while ERCP and a CT scan suggested interruption of bi le flow in the intrapancreatic tract of the common bile duct. An endoprosth esis was positioned in the common bile duct during the ERCP. Blood tests (b oth ELISA and Western blot techniques) showed positivity for anti-HIV antib odies and a CD4 count of 780/mmc (normal: 900-1,200 /mmc). A few days later , a drammatic increase of the size of a lymph node in this right axilla occ urred, rapidly reaching 5 cm of diameter. A biopsy was performed at this le vel, and histological examination revealed a high grade B-cell Burkitt type lymphoma. Bone marrow biopsy was negative, as well as lumbar puncture. Agg ressive chemotherapy with adriamycin, cyclophosphamide, bleomycine, eldesin e and prednisone, together with intratechal administration of methotrexate, was attempted. However, after a marginal and transient regression, the NHL rapidly progressed and the patient eventually died seven months after the diagnosis of NHL. A post mortem examination confirmed the diagnosis of Burk itt lymphoma of the peripancreatic and axillar lymph nodes, with diffusion to the leptomeninges, sub-aracnoideal spaces and encephalus. No signs of ly mphoma were detected in other nodal or extra nodal areas.