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CASE 4

CASE 4. 54 yo man HIV negative In serodiscordant relationship with untreated HIV positive man…ongoing frequent unprotected sex. CASE 4. CASE 4. January 2010 Found to have enlarging rt tonsillar lesion similar to oral h airy leukoplakia despite remaining HIV negative

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CASE 4

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  1. CASE 4 54 yo man HIV negative • In serodiscordant relationship with untreated HIV positive man…ongoing frequent unprotected sex

  2. CASE 4

  3. CASE 4 January 2010 • Found to have enlarging rttonsillar lesion similar to oral hairy leukoplakia despite remaining HIV negative Cause?...What would you do?

  4. CASE 4 • Biopsy reveals HPV related squamous cell cancer! • treated with chemo and radiotherapy ending in September 2010

  5. CASE 4 Cause?...What would you do?

  6. CASE 4 • Idiopathic CD4 T lymphocytopenia? • HIV with occult strain with negative conventional test? • Other immune disorder? • Not likely due to persistent leukopenia due to chemo or radiotherapy

  7. CASE 4 • Blood to be sent to NIHfor specialized HIV testing…ie PBMC culture/DNA testing • Also will look at CD8 activation markers and B cell immunity • TMP/SMX initiated for PCP prophylaxis

  8. CASE 4 • It is intriguing to ascribe HPV related cancer in part due to worsening immune deficiency over time…ie an opportunistic malignancy???

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