Between 80% and 90% of patients with AIDS-lymphoma complain of systemic "B" symptoms at initial diagnosis (8,38,39), consisting of fevers, drenching night sweats, and/or > 10% loss of normal body weight. Of importance, many opportunistic infections may present in similar fashion, including Mycobacterium avium complex (MAC), cytomegalovirus infection (CMV), Cryptococcus, and others. It is important for the clinician to consider lymphoma in the differential diagnosis of an HIV-infected patient with fever, weight loss, and/or night sweats.
Lymphomatous involvement of extranodal sites is very common in newly diagnosed patients with AIDS-lymphoma, with stage III or IV disease in approx 90% (8,38,39). Visceral sites most often involved by lymphoma include the central nervous system (CNS) in approx 25%, bone marrow in 20-25%, gastrointestinal tract in approx 20%, and liver in 12% (8). AIDS-lymphoma may also present in unusual sites, such as the rectum, oral cavity, gallbladder, heart, skin, earlobes, and others.
Aside from involvement of visceral organs, patients with AIDS-lymphoma also commonly present with peripheral and/or central lymphadenopathy. Peripheral lymph nodes may be extremely large, with a firm, rubbery consistency.
Specific symptoms of AIDS-lymphoma will depend upon the organ(s) involved. Patients with primary CNS lymphoma often complain of headache, seizures, focal neurologic defect, or altered mental status (40). Headache or cranial nerve palsy may occur in patients with leptomeningeal involvement, although approx 20% of patients with lymphoma cells in the spinal fluid will be asymptomatic (41). Gastrointestinal lymphoma may present with abdominal pain or distension, anorexia, nausea, or vomiting. Involvement of the rectum and/or perianal region often presents as a rectal mass, or pain upon defecation. Patients with bone marrow involvement have a statistically increased likelihood of leptomeningeal lymphoma (42). Of interest, no specific symptom is associated with marrow involvement, and hematologic parameters are similar in the presence or absence of lymphoma, with the exception of thrombocytopenia <100,000/DL, seen more often in patients in whom the marrow is involved (42).
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