A mediastinoscopy with biopsy showed HL (mixed cellularity type) with positive CD30 and CD15, weakly positive PAX-5, and a negative leukocyte common antigen (LCA). differentiation assay should undergo nucleic acid testing. Nevertheless, several instances of discordance between screening and confirmatory techniques have been described. It BMS-509744 is speculated that this might be due to coincidental cross-reaction of subtypes of polyclonal gamma globulin with the HIV p24 antigen. In conclusion, this case signifies the understanding of the HIV testing algorithm and the use of reflex testing in the context of a positive HIV test before disclosing such preliminary results to patients and/or physicians. strong class=”kwd-title” Keywords: hiv testing, false hiv test, hodgkin lymphoma, mediastinal mass Introduction The HIV-infected individuals have an increased predilection for growing malignancy?[1]. The United States Centers for Disease Control (CDC) has determined Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer as the “acquired immunodeficiency syndrome (AIDS) defining cancers.” A diagnosis of any one of these cancers marks the point at which HIV infection has progressed to AIDS. Also, people infected with HIV are at higher risk of several other types of cancer than the general population, and these are collectively described as non-AIDS-defining cancers (NADCs). These other malignancies include anal, liver, lung cancer, and Hodgkin lymphoma (HL) [2]. Thus, HIV testing is a part of routine testing in HL because of commonly anticipated association. Here, we report a compelling case of a patient with recently diagnosed HL, who found to be falsely positive for HIV on an initial diagnostic workup for HL. Case presentation A 38-year-old male with no significant past medical history presented to the ER with the chief complaint of a five-month history of hemoptysis. The hemoptysis is associated with mild right-sided chest pain, fever, night sweats, and unintentional weight loss (15 pounds in the last three months). He denied shortness of breath, sick contacts, and travel or incarceration history. He had no history of tobacco, drug, or alcohol use. He was in a monogamous relationship, and his family history was noncontributory. On examination, vitals were normal with a blood pressure of 112/60 mmHg, pulse rate of 80 beats/min, respiratory rate of 16 breaths/min, temperature of 98.5 degree Farenheit, and BMI of 19.1 with no palpable lymphadenopathy. Dull percussion was noted in the right middle lung zones. The rest of the clinical examination was normal. His blood workup showed a hemoglobin of 11.3 g/dL, white blood cells (WBCs) of 7200/mm3, and platelet count of 337 x 103/mm3. His lactate dehydrogenase (LDH) was normal at 161; his blood urea nitrogen (BUN), creatinine, and liver function tests were within normal ranges. Epstein-Barr virus (EBV) titers were negative. Chest X-ray (CXR) showed 8.8 cm x 5.9 cm lobulated right para hilar/right para-cardiac mass consistent with malignancy (Figure ?(Figure11). Open in a separate window Figure 1 Chest X-ray. The CT image Rabbit polyclonal to SUMO3 of the chest revealed a large right upper lobe mass encasing the bronchi and major vessels in the right lower lobe and right middle lobe (Figure ?(Figure22). Open in a separate window Figure 2 CT scan of chest. There were also multiple right lung nodules, predominantly pleural-based, likely representing lymphomatous involvement within the lung. A mediastinoscopy with biopsy showed HL (mixed cellularity type) with positive CD30 and CD15, weakly positive PAX-5, and a negative leukocyte common antigen (LCA). There was no phenotypic BMS-509744 evidence of blasts, myeloid dysmaturation, or non-Hodgkin lymphoma, and stains for acid-fast bacilli and fungus were negative. CT scan of the abdomen showed mesenteric and retroperitoneal lymphadenopathy with splenic lesions. A patient-confirmed HIV-1 and HIV-2 antibodies with P24 antigen were reactive, with an undetectable viral load. A sequential BMS-509744 repeat antigen-antibody test before the start of chemotherapy came back negative.? Conversation Hodgkin lymphoma is one of the NADCs, and its incidence with HIV illness may have improved as HIV-infected individuals are living longer and also considerably with the use of combination antiretroviral therapy (cART)?[2]. Therefore, HIV screening is definitely a part of routine screening in HL because of this generally anticipated association. Interestingly, the pattern of histologic subtypes of HL seen in HIV-infected individuals has a higher proportion of lymphocyte depletion (LD) and combined cellularity (MC)?[3-4]. Both subtypes of classical HL are related to more advanced immune compromise, while nodular sclerosis (NS) histology raises with higher CD4 counts than cART?[2]. It becomes crucial to test for HIV after diagnosing lymphoma, as the disease is more aggressive in HIV individuals, and response to chemotherapy can be affected by HIV due to certain factors. Levine et al.?[5]?analyzed the decreased response rates and inferior outcomes during the pre-cART era due to dose reductions.