HIV-associated non-Hodgkin lymphoma of the oral cavity complicated by superinfection with a multidrug-resistant pathogen: a case report with a fatal outcome

Abstract

Non-Hodgkin lymphoma in the oral cavity is rare and can mimic odontogenic infections, which delays early diagnosis, particularly in immunocompromised patients such as those with HIV infection. A 25-year-old male patient with a history of HIV infection and no antiretroviral therapy presented with severe pain in the right side of the face, trismus, and facial swelling. He reported a recent extraction of the lower right second molar (tooth 47), following which he experienced a slow progression with progressive edema and functional limitation. On clinical examination, facial cellulitis and active periodontal lesions were evident. Imaging studies, cultures, and an incisional biopsy of alveolar and bone tissue were performed. Histopathological and immunohistochemical analysis confirmed B-cell non-Hodgkin lymphoma. A colonoscopy was performed to assess the extent of the disease, identifying an abdominal mass with systemic involvement. The patient was hospitalized and developed a multidrug-resistant bacterial infection, so antimicrobial treatment was initiated while specialized oncological management was coordinated; however, he died during his hospitalization. This case highlights the importance of the dental role in the early detection of atypical oral lesions that may initially mimic common odontogenic processes. Clinical evaluation and the decision to perform complementary studies, such as biopsy, were decisive in establishing the diagnosis of non-Hodgkin lymphoma. In patients with untreated HIV infection, a timely dental approach is key to guiding the differential diagnosis and improving the prognosis.