Sir,
I read with interest the case report on the conjunctival leiomyosarcoma reported by Montes et al.[1] Leiomyosarcoma is one of the most common and serious smooth muscle tumors (SMTs) in the body. Patients infected with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) are susceptible to various types of tumors, including SMTs. There is a close association between Epstein–Barr virus (EBV) infection and SMTs evolution in patients infected with HIV/AIDS.[2] Moreover, SMTs in these patients typically arise in multiple and very unusual sites that are not often observed in SMTs among immunocompetent individuals.[3] To my knowledge, HIV infection is an important health problem in Spain. Although no recent data are yet present on the exact seroprevalence HIV infection in Spain, the available data pointed out that the overall HIV seroprevalence among persons seeking HIV testing was reported to be substantial (2.5%).[4] I presume that HIV infection should be critically considered in the studied patient with leiomyosarcoma affecting the unusual site. Hence, the diagnostic algorithm of immunohistochemical stains and in situ hybridization for EBV-encoded ribonucleic acid in the surgically resected tumor tissues as well as blood CD4 count and viral overload estimations for HIV infection was solicited. If that diagnostic algorithm was contemplated and it revealed underling EBV-HIV infection, the case in question could truly extend the spectrum of ophthalmic leiomyosarcoma associated with EBV-HIV infection rarely reported in the literature so far.[5]
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Conflicts of interest
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References
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