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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Epstein-Barr virus-positive diffuse large B-cell lymphoma with human immunodeficiency virus mimicking complicated frontal sinusitis: A case report
Seokho Yoon, Kyeong Hwa Ryu, Hye Jin Baek, Hyo Jung An, Yeon-Hee Joo
Seokho Yoon, Department of Nuclear Medicine and Molecular Imaging, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, South Korea
Kyeong Hwa Ryu, Hye Jin Baek, Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, South Korea
Hye Jin Baek, Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, South Korea
Hyo Jung An, Department of Pathology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, South Korea
Yeon-Hee Joo, Department of Otorhinolaryngology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, South Korea
Author contributions: Yoon S, Ryu KH and Baek HJ conceived and designed the study, reviewed the literature, and contributed to manuscript drafting; An HJ and Joo YH reviewed the cases and edited the manuscript; all authors issued final approval for the version to be submitted; all authors approved the manuscript for publication.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kyeong Hwa Ryu, MD, PhD, Assistant Professor, Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, South Korea. ryukh0329@gmail.com
Received: August 9, 2020
Peer-review started: August 9, 2020
First decision: December 14, 2020
Revised: December 14, 2020
Accepted: January 22, 2021
Article in press: January 22, 2021
Published online: March 6, 2021
BACKGROUND
Primary non-Hodgkin’s lymphoma of the frontal sinus is extremely rare. In addition, Epstein-Barr virus (EBV) has been reported to play a role in the development of human immunodeficiency virus (HIV)-related malignant lymphomas. To the best of our knowledge, there is no report for the HIV-associated, EBV-positive primary diffuse large B-cell lymphoma (DLBCL) in the frontal sinus.
CASE SUMMARY
We present a unique case of HIV-associated, EBV-positive DLBCL in the frontal sinus in a 46-year-old man. Computed tomography of paranasal sinuses revealed dense opacification of the right frontal sinus with combined soft tissue swelling. Based on the clinical and radiological findings, the initial diagnosis was complicated frontal sinusitis, presenting Pott’s puffy tumor. Unexpectedly, HIV testing was positive on preoperative laboratory test, and the frontal sinus lesion was confirmed as EBV-positive DLBCL on biopsy.
CONCLUSION
Through this article, we suggest that EBV-positive DLBCL should be considered as possible diagnosis for patients with nonspecific space-occupying lesion of the paranasal sinuses. We also highlight an importance of clinical suspicion in diagnosing HIV infection because HIV serology is not routinely tested in patients with paranasal sinus problem.
Core Tip: Primary diffuse large B-cell lymphoma in the frontal sinus is extremely rare. It can mimic complicated sinusitis and may be easily overlooked at the initial diagnostic workflow in the clinical practice. When we meet the frontal sinus opacification with combined overlying soft tissue swelling, it is important for the radiologists and clinicians to include the following disease entity in the differential diagnosis based on imaging findings; complicated sinusitis (Pott’s puffy tumor), unilateral non-Hodgkin’s lymphoma and destructive metastasis. Awareness and clinical suspicion of this disease are necessary for making an accurate diagnosis and appropriate treatment, particularly in patients with a history of sinusitis which does not response to medical treatment, or in human immunodeficiency virus-positive patients.
