Epstein-Barr associated to primary CNS lymphoma and disseminated BCG infection in a child with AIDS

FALLO, A.; DE MATTEO, E; PRECIADO, M. V.; CERQUEIRO, M.; SCOMBS, S.; PAOLA ANDREA CHABAY; LOPEZ, E.

International journal of infectious diseases : IJID : official publication of the International Soci

Elsevier

Año: 2005 vol. 9 p. 96 - 103

1201-9712

AIDS patients are at increased risk of developing concurrent infections with viral, parasitic, fungal or mycobacterial organisms. They can present  constitutional symptoms of fever and weight loss, either due to infections or an underlying lymphoma which may coexist. We report the case of an AIDS child with a mild HIV encephalopathy, who during the course of a confirmed disseminated mycobacterial disease presented neurological impairment. Postmortem examination revealed disseminated BCG bacillus infection and Epstein-Barr associated primary CNS lymphoma. We assessed EBV presence by LMP-1 protein labeling by immunohistochemistry and in situ hybridization for EBERs in formalin-fixed and paraffin-embedded sections. BCG vaccination among HIV-1 infected children has the risk of disseminated BCG infection; therefore BCG immunization programs should be reconsidered for children at risk of HIV infection, because the risk of delayed complications is independent of the immunological status at the time of the vaccination.  Primary central nervous system lymphoma represents a frequent complication of HIV infection in adults, occurring in as many 6-10% of patients with AIDS, however, only isolated cases of primary CNS lymphoma occurring in HIV infected  children have been reported, and a striking association with EBV infection have been demonstrated in them. This association has not heretofore been reported in our country.