A rare case of supratentorial hemangioblastoma in HIV/AIDS patient with multiple opportunistic infections

Background: An opportunistic infection was a deathly problem in HIV/AIDS. A patient with a CD4 count below 200 cells/μL poses a high risk to suffer from multiple opportunistic infections. Moreover, several studies have shown that HIV/AIDS can induce malignancy. Here we report an HIV patient with multiple opportunistic infections and supratentorial hemangioblastoma. Case description: A 33-year-old housewife with known HIV positive status, suspected of being transmitted with HIV by her husband who had died in 2014. Since then, she took antiretroviral drugs for 3 months and stopped it by herself until now. She was admitted to the hospital in lethargic condition with severe headaches, nausea, vomiting, difficulty to swallow and one-time seizure. Physical examination showed decreased vision of the right eye, oral thrush, crackles in both lung apices, and signs of moderate mild dehydration. Laboratory results were microcytic hypochromic anemia, hyponatremia, hypokalemia, hypocalcemia, and hypoalbuminemia. The CD4 counts were 4 cells/μL, and Reactive IgG and IgM for Cytomegalovirus. The X-ray and CT scan of thorax indicated active pulmonary tuberculosis infection. Funduscopic examination showed a cotton wool spot, a typical sign of Cytomegalovirus retinitis. The contrast-enhanced MRI of the brain revealed a suggestive image of supratentorial hemangioblastoma. The patient was treated with lamivudine, tenofovir, and efavirenz as antiretroviral drugs; rifampicin, isoniazid, pyrazinamide, and ethambutol as antituberculosis drugs; intravenous ganciclovir; intravenous fluconazole; nutritional therapy and was planned for craniotomy, unfortunately, the patient refused surgery. Discussion: Supratentorial hemangioblastoma, a rare type of tumor that counts only 1–2% of all hemangioblastomas, and 8–12% of all types of intracranial neoplasms. The cause of this malignancy in this patient is unknown. A very low CD4 evoked multiple infections complicating the patient. Conclusion: Adherence to treatment is an important key to prevent the manifestation of various opportunistic infections and even malignancy in HIV patients. Proper holistic treatment is needed to improve the patient's condition.