Double-Hit Diffuse Large B-Cell Lymphoma in AIDS

Diffuse large B-cell lymphoma (DLBCL) is the most common type of immunoblastic lymphoma associated with AIDS, with the stomach being the most frequent extranodal site of involvement. Despite the widespread use of combined antiretroviral therapy (cART), the incidence of systemic lymphomas remains relatively high. These lymphomas often present in the early stages of AIDS as high-grade malignancies. We report the case of a man in his early 30s who initially presented with chronic cough and weight loss, diagnosed with pulmonary tuberculosis and found to be HIV-positive. Within a few months, he returned with persistent abdominal pain and progressive weight loss. Imaging revealed a gastric ulcer, and biopsy confirmed the diagnosis of DLBCL. Although cART is now available and started early upon an HIV diagnosis, vigilant surveillance, early diagnosis, and prompt initiation of chemotherapy are critical for achieving an adequate response and remission.