Endoscopic Progression of Gastric DLBCL in an HIV-Positive Patient: A Case Report and Literature Review

INTRODUCTION: Gastric Diffuse Large B-Cell Lymphoma (DLBCL) is an aggressive type of non-Hodgkin lymphoma (NHL) that originates from B lymphocytes. It is the most common subtype among gastric lymphomas, accounting for approximately 30-40% of all lymphoma cases. The incidence of DLBCL varies depending on geographic region and age, with an annual incidence of approximately 5-7 cases per 100,000 people in Western countries. Patients with human immunodeficiency virus (HIV) infection have a significantly increased risk of developing lymphomas, including DLBCL, due to chronic immunosuppression. Before the advent of Highly Active Antiretroviral Therapy (HAART), the incidence of DLBCL in patients with HIV was estimated to be 60 to 200 times higher than in the general population. After the introduction of HAART, the incidence of DLBCL decreased to approximately 24 times higher than in the general population. CD4 lymphocyte count is a key factor. Studies have shown that patients with lower CD4 counts and higher viral loads had an increased risk of systemic NHL, while the use of HAART was associated with a reduced incidence of NHL. In HIV-positive patients, DLBCL is often associated with greater aggressiveness and a less favorable prognosis compared to immunocompetent patients. CASE PRESENTATION: This case report describes a 67-year-old woman with a known diagnosis of HIV infection who presented with abdominal pain, unintentional weight loss, melena, and severe anemia. After 3 weeks from symptoms onset, an esophagogastroduodenoscopy revealed numerous ulcerated areas in the stomach. Gastric biopsies confirmed the diagnosis of DLBCL, ABC-like subtype. CONCLUSION: This case highlights the critical importance of early upper gastrointestinal endoscopy in the follow-up of gastric lesions in HIV-positive patients, demonstrating how timely endoscopic monitoring serves as an essential tool to accurately assess the therapeutic effectiveness of antiviral and antitumor treatments. Direct visualization of the lesions' response enables prompt adjustment of therapy, significantly improving clinical outcomes. Moreover, the optimal management of such complex cases necessitates close multidisciplinary collaboration among hematologists, gastroenterologists, and infectious disease specialists. This interdisciplinary synergy is key to ensuring an integrated approach that enhances diagnostic precision, therapeutic strategies, and follow-up protocols, ultimately aiming to optimize patient outcomes and quality of life.