Hodgkin's disease of the tongue in a homosexual HIV‐infected patient

We report a case of Hodgkin’s disease of the tongue in a patient with human immunodeficiency virus (HIV) infection. This peculiar localization has never been reported before. A 24-year-old white homosexual man was seen in December 1989 because of weight loss and painful ulceration of the tongue. The patient had acquired immunodeficiency syndrome (AIDS) as defined by human immunodeficiency virus (H1V)-seropositive status since 1987 and Pneumocystis carinii pneumonia in 1988. He had a history of frequent sexual oral active intercourse. There was no peripheral adenopathy or hepatosplenomegaly . Laboratory values showed a leukocyte count of 2.6 X 109/L with 60% neutrophils and 26% lymphocytes; the hematocrit was 35%, and the platelet count was 101 X 109/L. The CD4 cell count was 48 X 109/L, and the CD8 cell count was 450 X 106/L. Serum p24 antigen was detectable (330 pg/ml). Magnetic resonance imaging (MRI) of the tongue showed limited locoregional involvement. Computed tomographic (CT) scanning of the thorax, abdomen, and brain was normal. Biopsy of the tongue showed mixed cellularity Hodgkin’s disease. Bone marrow biopsy was normal. The patient’s lesion was thus classified as Hodgkin’s disease stage IEB. He received three courses of vinblastine. Local radiotherapy was initiated and completed within 4 weeks (dose 40 Gy) achieving complete remission. By January 1991, the patient is still in remission and has not experienced further opportunistic infection. In HIV-infected patients, Hodgkin’s disease presents in advanced stages and involves extranodal sites [I]. Rectal Hodgkin’s disease has been reported in a homosexual HIV-infected man [2]. Non-Hodgkin’s lymphoma (NHL), squamous cell carcinoma, and cloacogenic carcinoma have also been recognized in anorectal primitive forms in homosexual men [3,4]. Likewise, preferential oral localization of neoplasia, including Kaposi’s sarcoma, NHL, and squamous cell dysplasia, appears abnormally frequently in these patients [5]. These observations raise the possibility of a link between an infectious exposure through sexual contacts and the development of neoplasia at the site of sexual contact. In our patient, Hodgkin’s disease developed on a site of repeated and frequent exposures to many infectious agents. Epstein-Barr virus (EBV) could play an important role in this setting. EBV is probably the main agent responsible for hairy leukoplakia of the tongue and is associated with most of NHL observed in patients with primary or secondary immunodeficiency [6]. Furthermore, EBV DNA has been found in ReedSternberg cells [7] and may be associated with Hodgkin’s disease observed in HIV-infected patients [8]. However, since these peculiar localizations of neoplasia were not observed before the emergence of HIV infection, one cannot ascertain a causal link between such malignancies and EBV alone. The causal role of a viral coactivation at sites of repeated contacts with HIV, as the oral or rectal mucosa, may be suspected.