Patient With HIV-Associated Plasmablastic Lymphoma Responding to Bortezomib Alone and in Combination With Dexamethasone, Gemcitabine, Oxaliplatin, Cytarabine, and Pegfilgrastim Chemotherapy and Lenalidomide Alone

A 19-year-old vertically transmitted naive HIV-positive man was admitted to our emergency room in late February 2009 presenting with fever, night sweats, numerous skin nodules, and rapidly growing generalized lymphadenopathy. Computed tomography (CT; Fig 1) showed multiple liver and splenic nodules (Figs 1A and Both skin nodules and a laterocervical lymph node were biopsied. Histologic evaluation confirmed the presence of large atypical cell infiltrates with plasmacytoid and anaplastic features, which were strongly positive (more than 80%) for CD138, CD43, and Ki-67 and negative for CD3, CD20, CD45, multiple myeloma oncogene-1, Epstein-Barr virus, and human herpes virus 8 (Figs 2A to 2F; EMA, epithelial membrane antigen). No abnormal findings were noted in the bone marrow trephine biopsy. The patient was diagnosed with stage IVB HIV-