PRIMARY HEPATIC LYMPHOMA IN A RVD POSITIVE PATIENT : PRIMARY HEPATIC LYMPHOMA IN A RVD POSITIVE PATIENT

Primary hepatic lymphoma (PHL) is an exceptionally rare malignancy, comprising less than 1% of lymphomas and 0.1% of primary liver tumors. We report a case of a 24-year-old HIV-positive male presenting with abdominal distension, jaundice, fever, recurrent asymptomatic hypoglycemia, hypercalcemia, and persistent lactic acidosis, indicative of metabolic derangements such as the Warburg effect. Clinical evaluation revealed firm hepatomegaly, elevated liver enzymes, and hypoechoic liver lesions with intrahepatic duct dilations on imaging. A liver biopsy confirmed diffuse large B-cell lymphoma (DLBCL). Despite normal alpha-fetoprotein and tumor markers, the diagnosis was supported by histopathology showing CD20 positivity and a high Ki67 index (>90%). The patient was treated with intravenous dexamethasone, prophylactic antibiotics, and was initiated on highly active antiretroviral therapy (HAART). Pre-phase cyclophosphamide was started, with plans for combination chemotherapy using CHOP (cyclophosphamide, hydroxy-doxorubicin, vincristine sulfate, and prednisone) and Rituximab. This case underscores the importance of recognizing hypercalcemia, lactic acidosis, and hypoglycemia in PHL, especially in immunocompromised patients, to enable early diagnosis and prompt, targeted therapy. Early intervention and aggressive management are critical to achieving remission in this rare and challenging condition.