Extracorporeal Membrane Oxygenation with rituximab-combined chemotherapy in AIDS-associated primary cardiac lymphoma: A case report.
Hoyuri FuseyaTakuro YoshimuraMinako TsutsumiYosuke NakayaMirei HoriuchiMasahiro YoshidaYoshiki HayashiTakafumi NakaoTakeshi InoueTakahisa YamanePublished in: Clinical case reports (2021)
Although effective combination of antiretroviral medications is being developed, the incidence of non-Hodgkin lymphoma (NHL) with human immunodeficiency/acquired immunodeficiency syndrome (HIV/AIDS) still remains significantly higher than that in individuals without infection. Primary cardiac lymphoma (PCL) is an NHL that involves the heart and/or the pericardium. PCL is very rare and often causes serious complications, which can be a diagnostic challenge. To our knowledge, no study has reported the measurement of rituximab concentration under venoarterial extracorporeal membrane oxygenation (VA-ECMO). Herein, we report the case of a 54-year-old male patient with AIDS-associated primary cardiac NHL who developed right ventricular outflow tract obstruction. The patient experienced fatigue and dyspnea on exertion. Contrast-enhanced computed tomography showed a bulky tumor mass in his right atrium and ventricle, and an echocardiogram revealed severe hypokinesis of his heart and poor cardiac output. A biopsy was performed, and immunohistochemistry revealed diffuse large B-cell lymphoma. Therefore, he was treated with rituximab-combined chemotherapy under VA-ECMO. Blood levels of rituximab were measured during chemotherapy with VA-ECMO. Thereafter, he was temporarily discharged from the hospital. This clinical case suggests that VA-ECMO and rituximab-combined chemotherapy are useful in rescuing patients with severe cardiopulmonary failure due to AIDS-associated PCL.
Keyphrases
- extracorporeal membrane oxygenation
- diffuse large b cell lymphoma
- acute respiratory distress syndrome
- hiv aids
- epstein barr virus
- computed tomography
- antiretroviral therapy
- contrast enhanced
- respiratory failure
- left ventricular
- locally advanced
- magnetic resonance imaging
- hiv infected
- case report
- human immunodeficiency virus
- heart failure
- endothelial cells
- early onset
- hiv positive
- risk factors
- magnetic resonance
- diffusion weighted
- single cell
- positron emission tomography
- pulmonary artery
- chronic lymphocytic leukemia
- ultrasound guided
- diffusion weighted imaging
- pulmonary embolism
- physical activity
- electronic health record
- depressive symptoms