Copyright © 2009 by Lippincott Williams & Wilkins.Unauthorized reproduction of this article is prohibited. Case Report Gastric Burkitt Lymphoma: A Rare Cause of Upper Gastrointestinal Bleeding in a Child With HIV/AIDS  Ashish Chogle,  Katrina Nguyen,  Farrah Lazare, y Miguel Guzman, y Virginia Anderson, and  William R. Treem Departments of  Pediatric Gastroenterology and Nutrition and { Pathology, State University of New York Downstate Medical Center, Brooklyn, NY Upper gastrointestinal (UGI) bleeding is an uncom- mon manifestation of acquired immune deficiency syn- drome (AIDS) despite frequent involvement of the gastrointestinal tract by infections, malignancies, and other disorders (1). Primary gastric Burkitt lymphoma is rare in children; only 4 pediatric cases of gastric Burkitt lymphomas have been reported previously (2–4). According to our review of the literature, this is the first case report of a child with human immunodeficiency virus (HIV)/AIDS presenting with upper gastrointestinal bleeding due to gastric Burkitt lymphoma. An 11-year-old African American male with conge- nital HIV/AIDS, noncompliant with a highly active antiretroviral regimen for at least 2 months, was admitted to the hospital with a 5-day history of fever and abdomi- nal pain. The patient was noted to have guaiac-positive stools and subsequently developed frank melena. He was started on intravenous lansoprazole. A nasogastric tube was inserted and bloody gastric contents were aspirated. The patient appeared malnourished and had periorbital edema. He was pale and tachycardic with a blood pres- sure of 108/65 mmHg. His abdomen was soft, flat, and nontender. The liver was palpated 4 cm below the right costal margin in the midclavicular line. The spleen measured 6 cm below the left costal margin. A gastro- stomy tube was in place and the peristomal site showed the presence of granulation tissue. Laboratory investigations revealed hemoglobin of 6 g/dL. The white blood count was 23.5  10 9 /L, and the platelet count was 420  10 9 /L. The prothrombin time was 14.2 seconds with a partial thromboplastin time of 27.4 seconds and an International Normalized Ratio of 1.4. His CD4 count was 1138/mm 3 and the viral load was >750,000 HIV copies per milliliter. The serum uric acid level was high at 13 mg/dL and the lactate dehydrogenase was elevated at 900U/L. Both blood urea nitrogen and creatinine were elevated at 28 mg/dL and 2.2 mg/dL, respectively. The AST and ALT were 143 U/L and 43U/L, respectively, with a total bilirubin of 0.2mg/dL. Total protein was normal at 6g/dL, but the albumin was low at 2.1 g/dL. The patient received 2 units of packed red blood cells. An upper endoscopy revealed diffusely thickened gastric folds and numerous large ulcers with deep craters in the body of the stomach (Fig. 1A). Multiple gastric erosions and ulcers also were noted, showing stigmata of recent bleeding (Fig. 1B). These lesions were treated with injections of 1:10,000 epinephrine via a 25-gauge scler- otherapy needle. The esophageal and duodenal mucosa appeared normal. After this procedure, there was no further active bleeding from the gastrointestinal tract. Histological examination of the gastric biopsy speci- mens revealed diffuse infiltration of the mucosa by mono- morphic, medium-size, neoplastic-appearing lymphocytes showing a ‘‘starry sky’’ pattern (Fig. 2). Immunostains using the anti–CD20 antibodies (a pan–B cell marker) showed positive cells infiltrating the gastric mucosa. Immunostains for anti–CD 10 (a marker of germinal center cells and Burkitt lymphoma cells) showed the presence of infiltrative neoplastic lymphocytes within the gastric mucosa. There also were scattered CD3– positive T lymphocytes present within the mucosa. The findings were indicative of a B cell Burkitt type lym- phoma. Immunostains for Helicobacter pylori, Epstein- Barr virus, and cytomegalovirus in duodenal, gastric, and esophageal biopsies were negative. A bone marrow biopsy showed a markedly hypercel- lular marrow with a moderate increase in megakaryo- cytes. Foci of small to medium-sized atypical lympho- cytes with pleomorphic changes were present. The Received June 18, 2007; accepted September 28, 2007. Address correspondence and reprint requests to Ashish Chogle, MD, MPH, 2300 N Children’s Plaza, Chicago, IL 60614 (e-mail: achogle@ gmail.com). The authors report no conflicts of interest. Journal of Pediatric Gastroenterology and Nutrition 48:237–239 # 2009 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition 237