Burkitt's/Burkitt's-like lymphoma presenting as bacterial sinusitis in twoHIV-infected children

Two children (ages 12 and 13 years) with transfusion-acquired human immunod eficiency virus (HIV) infection presented with facial pain and rhinorrhea. Radiographic imaging showed extensive paranasal sinus disease, presumed to be bacterial sinusitis, and the patients were treated with broad-spectrum o ral antibiotics. Both patients were unresponsive to oral agents and were sw itched to intravenous antibiotics. Despite aggressive antimicrobial therapy , one patient (case 1) developed increased periorbital swelling and proptos is, and the other patient (case 2) developed symptoms of nasopharyngeal obs truction. Repeat imaging showed progression of the infiltrative process ext ending from the paranasal sinuses into the orbit (case 1), and nasopharynx (case 2). Surgical exploration and tissue biopsies were performed on both p atients and the histopathology was consistent with Burkitt's/Burkitt's-like lymphoma. Combination systemic and intrathecal chemotherapy resulted in a complete remission in both patients. These reports illustrate the fact that Burkitt's/Burkitt's-like lymphoma in the paranasal sinuses may initially m asquerade as an acute bacterial sinusitis. The ability of the tumor to exte nd rapidly from the sinuses into the orbit and nasopharynx reinforces the i mportance of early diagnosis and treatment. Burkitt's/Burkitt's-like lympho ma in the paranasal sinuses has not been previously described in HIV-infect ed children.