Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report.

BACKGROUND: Actinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown. CASE PRESENTATION: A 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma. CONCLUSION: Esophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started.

Diagnóstico de un quiste duodeno-colónico con contenido inflamatorio derivado de la metástasis de adenocarcinoma de vesícula biliar: reporte de caso.

The existence of a cystic mass which walls originated from a metastatic gallbladder adenocarcinoma is infrequent. We present the case of 68-year-old male that present to the emergency department with abdominal distention, hyporexia and jaundice. Upon exploratory laparotomy, a duodeno-colonic cyst with walls formed by metastatic cells derived from a Gallbladder Adenocarcinoma. Metastatic disease from a gallbladder adenocarcinoma to transverse colon and duodenum formed adherences between both organs, leading to the formation of cystic mass. Cancer cells have multiple adaptation mechanisms in order to survive harsh environments.

La existencia de un quiste cuyas paredes se originaron de una metástasis de adenocarcinoma de vesícula biliar es infrecuente. Varón de 68 años con distensión abdominal, hiporexia e ictericia. En la laparotomía exploratoria se evidencia un quiste duodeno-colónico de paredes conformadas por células metastásicas producto de un adenocarcinoma de vesícula biliar. La metástasis del adenocarcinoma de vesícula biliar hacia colon transverso y duodeno formaron adherencias entre ambos órganos, conduciendo a la formación de una masa quística. Las células cancerígenas pueden adaptarse de muchas maneras para sobrevivir en entornos adversos.