EP418 - Hemicolectomy for Burkitt Lymphoma-Induced Colonic Perforation in an HIV Patient: A Case Report

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Purpose/Background: Burkitt Lymphoma (BL) is an aggressive non-Hodgkin lymphoma caused by the rapid proliferation of B cells. BL is classified into three types: endemic, sporadic, and immunodeficiency-related, the latter being closely associated with HIV infection. While BL often involves the gastrointestinal tract, especially the ileocecal region, isolated colonic involvement is rare. BL accounts for 40% of all HIV-associated lymphomas, a significant proportion.

Methods/Interventions: Here we present a case report of Burkitt lymphoma of the colon on an HIV-positive patient who presented with acute abdomen.

Results/Outcomes: A 37-year-old Hispanic male presented with a 3-day history of worsening abdominal pain, initially diffuse but later localizing to the right iliac fossa. On examination, the patient was hemodynamically stable with localized tenderness. Imaging showed concentric thickening of the transverse colon at the hepatic flexure with bowel dilation and free air suggestive of perforation. The patient underwent an urgent exploratory laparotomy, which revealed three perforations in the cecum, along with a palpable mass at the hepatic flexure. A right hemicolectomy was performed, including resection of the terminal ileum and proximal transverse colon. Pathology confirmed Burkitt lymphoma with MYC rearrangement. The patient’s postoperative course was unremarkable, and he was discharged in stable condition after seven days.

Conclusion/Discussion: BL in HIV-positive patients often presents with extranodal involvement, most commonly in the gastrointestinal tract and bone marrow. Colonic involvement is rare and poses diagnostic challenges. BL can mimic other gastrointestinal conditions, delaying diagnosis. For example, Panaccio et al. (2018) reported a case of BL presenting as ileocecal intussusception, a condition that obstructs the bowel. Similarly, Sato et al. (2022) emphasized the diagnostic difficulties of colonic BL in HIV-positive patients. Surgical intervention is crucial in managing acute complications such as perforation or obstruction, although chemotherapy remains the primary treatment. In this case, the patient underwent a right hemicolectomy, followed by postoperative chemotherapy.

The importance of early chemotherapy following surgery is well documented. Dinh et al. (2009) reported improved outcomes in HIV-positive patients with colorectal BL who received timely intervention. Burchard et al. (2020) also highlighted the importance of surgical resection in colonic BL, especially in trauma settings. Sotiropoulou et al. (2020) reinforced the need for early surgical intervention in cases of bowel obstruction caused by BL.

Chemotherapy regimens such as CODOX-M/IVAC and DA-EPOCH-R have shown excellent results in treating both HIV-positive and HIV-negative patients with BL, and these are well tolerated when combined with ART. CNS prophylaxis is essential due to the high risk of CNS involvement in BL, even in cases without initial CNS disease. The prognosis of HIV-associated BL has improved significantly with ART and modern chemotherapy, with survival rates now comparable to the general population. Early diagnosis and multimodal treatment, including surgery and chemotherapy, are critical for optimal outcomes in complex cases involving both HIV and BL.