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

Abstract

Non-Hodgkin lymphoma of the oral cavity is uncommon and can mimic odontogenic infections, delaying early diagnosis, particularly in immunocompromised patients such as those with HIV infection. A 25-year-old male patient with a history of HIV infection not on antiretroviral therapy presented with severe pain in the right hemiface, trismus, and facial swelling. He reported a recent extraction of the lower right second molar (tooth 47), after which he developed a torpid course with progressive edema and functional limitation. Clinical examination revealed facial cellulitis and active periodontal lesions. Imaging studies, cultures, and an incisional biopsy of alveolar and bone tissue were performed. Histopathological and immunohistochemical analysis confirmed B-cell non-Hodgkin lymphoma. Staging was completed with colonoscopy, which identified an abdominal mass with systemic involvement. The patient was hospitalized and developed an infection caused by a multidrug-resistant organism. Antimicrobial treatment was initiated while specialized oncologic management was coordinated; however, he had a fatal outcome during hospitalization. This case highlights the importance of the dental provider's 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 untreated HIV-infected patients, timely dental care is key to guiding the differential diagnosis and improving prognosis.