Abstract

A 43-year-old man with HIV/AIDS on antiretroviral therapy with an undetectable viral load but low CD4 count (nadir <35) developed hyperpigmented plaques on the extremities, subcutaneous nodules on the back, and a pink mass within the right nasal vestibule. Biopsies were performed of each of the three morphologies. Biopsy of a hyperpigmented plaque on the forearm showed Kaposi sarcoma. Biopsies from both the upper back nodule and nasal cavity lesion revealed a dense infiltrate of atypical plasmacytoid cells that stained diffusely positive for HHV8, EBER (EBV), CD3, and MUM-1, consistent with extracavitary primary effusion lymphoma (PEL) versus HIV-associated plasmablastic lymphoma with epiphenomenal HHV8 positivity. Subsequent positive PET-CT and lymph node biopsies confirmed a diagnosis of HHV8-associated multicentric Castleman’s disease. The pathological findings in this patient present an unusual case of multiple HHV8-associated disease entities developing concurrently in the setting of suppressed HIV and highlight the importance of sampling lesions with different morphologies despite simultaneous development.