Mesothelioma in an HIV/AIDS patient without history of asbestos exposure: possible role for immunosuppression in mesothelioma: a case report

Our plain-English summary of Mesothelioma in an HIV/AIDS patient without history of asbestos exposure: possible role for immunosuppression in mesothelioma: a case report, by C.O. James, A.W. Woods, P. Arya, et al (Cases Journal, 2009).

The study

• Authors: C.O. James, A.W. Woods, P. Arya, K.A. Abuelgasim, L.T. Heath, A. Sitapati
• Journal: Cases Journal
• Published: 2009;2:7498
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We describe a 41-year-old African-American male who initially presented in respiratory distress. He had a positive history of asthma, cigarette smoking, and only recent possible asbestos exposure six months prior to onset of symptoms. Mesothelioma was suspected after chest radiography and PET-CT, and confirmed by immunohistochemical tissue analysis. We postulate that immunosuppression enhances susceptibility to mesothelioma, since weakened immune systems are present in both HIV/AIDS patients like this 41-year-old man, and elderly patients who compose the population that classically presents with mesothelioma. Furthermore, immunosuppression may be a prerequisite to the development of mesothelioma.

In plain English

This case report described a 41-year-old African-American man with HIV, which had progressed to AIDS over the previous 3 years. He came to an emergency department with severe shortness of breath and right-sided chest pain. He had asthma and a 20 pack-year smoking history. For 30 years he had worked in hotel housekeeping and occasionally as a shoe shiner, with no mining, milling, construction, shipyard or plumbing work. About a year earlier he had helped demolish a house over 8 hours. The authors said it was unclear whether this involved asbestos. Scans showed nodular thickening of the lining around the left lung, nodules in the right lung and a mass in the right adrenal gland. Tissue staining was consistent with malignant mesothelioma of the left pleura that had spread to the adrenal gland, staged as stage IV. Despite treatment that included pemetrexed, cisplatin and anti-retroviral therapy, he died. Drawing on other published reports, the authors suggested that weakened immunity may play a role in mesothelioma, possibly as a prerequisite. This report describes one patient and does not measure risk.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 41-year-old African-American man with asthma, HIV that had progressed to AIDS in the past 3 years, chronic alcohol and illicit drug use, and 20 pack-years of cigarette smoking
• Exposure: No occupational history of mining or milling, construction, shipyard work or plumbing. He had worked about 30 years in hotel housekeeping and occasionally as a shoe shiner. He helped demolish a house over 8 hours about 1 year earlier, and it was unclear whether this involved asbestos. No fiber type is given.
• Main results:
  • CT of the chest and abdomen showed nodules in the right lung consistent with metastatic disease, and a necrotic mass in the right adrenal gland
  • Tumor cells from the left pleura and the right adrenal mass were strongly positive for cytokeratin 7, focally positive for calretinin and cytokeratin 5/6, and negative for TTF-1
  • The staining profile was consistent with primary malignant mesothelioma of the left pleura, with spread to the right adrenal gland
  • The mesothelioma was stage IV under the Butchart system
  • The patient died of complications of spreading mesothelioma and HIV/AIDS, despite the treatments described
• The authors' conclusion: Based on published reports of mesothelioma in people with SV-40 infection, HIV/AIDS, organ transplants and old age, the authors suggested that immunosuppression may play a role in mesothelioma, possibly as a prerequisite for it
• Limitations the authors state:
  • The authors noted that the patient's young age conflicts with the usual 30 to 50 year interval between exposure and mesothelioma
  • Whether the house demolition involved asbestos exposure was unclear

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, PET-CT.

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