Epstein-Barr virus (EBV)-associated smooth muscle tumor of the central nervous system in an HIV patient: diagnostic and therapeutic challenges

Epstein-Barr virus (EBV)-associated smooth muscle tumor (EBV-SMT) is a rare spindle cell tumor found in immunocompromised patients with HIV. This case report presents a patient with HIV-positive Epstein-Barr virus (EBV)-associated smooth muscle tumor (EBV-SMT) involving the brain and spine-a 39-year-old Hispanic female with HIV presented with severe headache, neck pain, and seizure-like activity. Magnetic resonance imaging (MRI) revealed multiple brain masses, prompting a diagnostic cerebral angiogram and subsequent surgery to remove them. Despite initial improvement, the patient later succumbed to aspiration pneumonia and cardiac arrest. Epstein-Barr virus (EBV)-associated smooth muscle rare tumors (EBV-SMTs) in HIV patients with low CD4 counts require clinical suspicion and Epstein-Barr virus (EBV) involvement in brain tumor diagnosis. Early HIV detection, CD4 monitoring, and antiretroviral therapy (ART) management can decrease the risk of these malignancies.