A 55 year-old Hispanic female with a history of human immunodeficiency virus (HIV) (recently started on highly active antiretroviral therapy, CD4 count of 213 cells/mm3, viral load of 69,835 copies/mL), and non-pulmonary tuberculosis treated in 2009, presented for induction chemotherapy for her recently diagnosed Burkitt’s lymphoma. Of note, she had a two-month history of abdominal pain,nausea and vomiting, anorexia and headache when she presented to her outpatient physician and was found to have hepatic masses on imaging that were biopsied. Physical examination was revealing for a right upper quadrant abdominal mass that was tender to palpation The patient had a negative Murphy’s sign and no rebound or guarding noted. In particular, cardiac auscultation was normal. On staging scans, however, she was noted incidentally to have thickening of the anterior wall of the left atrium and left atrial septum. Likewise, on echocardiography, she was found to have multiple atrial masses involving the septum, anterior left atrial free wall and superior right atrium suggestive of tumor infiltration.
Burkitt’s lymphoma is a B cell non-Hodgkin lymphoma characterized by dysregulation of the c-myc gene by chromosomal translocations, most commonly from chromosome 8 to chromosome 14. The three subsets of Burkitt’s lymphoma include sporadic, African-endemic and immunodeficiency-associated. The endemic form commonly presents as a large jaw mass while the sporadic and immunodeficiency-associated forms typically present with abdominal masses. Burkitt’s lymphoma is an AIDS defining illness.It is rare for there to be cardiac involvement in this disease. There are only 24 cases of Burkitt’s lymphoma with cardiac involvement reported in literature. Patients with cardiac masses are typically asymptomatic at presentation and physical examination may reveal no cardiac abnormalities. Some patients may present with a murmur depending on location of the tumor. The masses are diagnosed by cardiac echocardiogram. Treatment includes chemotherapy with central nervous system chemoprophylaxis with multiple therapeutic regimens used without one superior treatment being documented. Rituximab is often added to regimens to further potentiate effects of chemotherapy. Due to the rapid response to chemotherapy and the systemic nature of Burkitt’s lymphoma, there is no role for radiation in treatment. There are also case reports of surgical intervention for removal of cardiac masses. Prognosis ranges from resolution of disease and cardiac involvement to death.
Cardiac involvement in Burkitt’s lymphoma is rare but can occur and present in a variety of manners from asymptomatic with no findings on physical exam to complete atrioventricular block. Remission without cardiac complications has been demonstrated in some cases.