Burkitt’s Lymphoma of the Uterine Cervix in a Woman with Advanced HIV Disease: A Case Report on Challenges with Its Management in a Low Resource Setting

Lisa Erin de Miranda,1,2 Bernard Uzabakiriho,1,2 Melanie Louw,3 Nnabuike Chibuoke Ngene1,2 1Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa; 3School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaCorrespondence: Bernard Uzabakiriho; Lisa Erin De Miranda, Rahima Moosa Mother and Child Hospital, Fuel Road & Oudtshoorn St, Coronationville, Johannesburg, 2112, South Africa, Tel +27114709095, Email [email protected]; [email protected]: Burkitt’s lymphoma (BL) affecting the female genital tract is rare.Objective: The aim of this paper is to report BL of the cervix in an HIV-positive patient to discuss the fatality of the condition and ways to mitigate it through advocacy for improved health care delivery in resource limited settings.Methods: The patient was a 29-year-old woman, Para 1, with abnormal vaginal bleeding for a month and living with HIV and had a CD4 of 26 cells/μL. The histological examination of the cervical biopsy confirmed an extra-nodal BL. She had International Federation of Gynecology and Obstetrics (FIGO) stage 3B cervical cancer based on presence of hydronephrosis and pelvic wall involvement. The patient was reviewed at the oncology multidisciplinary meeting and required chemoradiation. There was delay in her management due to a long waiting list for chemoradiation at oncology unit in the referral center and the patient demised 43 days after diagnosis and did not receive the treatment.Results: This case suggests that women living with HIV who have BL should be fast-tracked for treatment as HIV viremia may worsen the prognosis of the malignancy. Following the encounter with the index patient an advocacy action plan has been made by the oncology multidisciplinary team to prioritize the treatment of women with aggressive histological types of cervical cancer.Conclusion: A long waiting list for chemoradiation in low resource settings may delay management of advanced BL of the cervix. Inadequate cervical cancer screening and delays in diagnosis are other barriers to the care of women with aggressive cervical cancers in low resource settings. Systemic changes in healthcare delivery are therefore required in many low resource settings. Advocacy for patients particularly those with aggressive diseases using the index case as a point of reference is ideal and should be promoted in resource-limited settings to improve health care delivery.Keywords: Burkitt’s lymphoma, cervical cancer, chemoradiation, delay in treatment, non-Hodgkin’s lymphoma, patient advocacy