Sir,
I read with interest the case report by Pavan et al. on the mesenteric leiomyoma in a Brazilian child.[1] I presume that the following factor could contribute to the early development of big size leiomyoma measuring 22 cm × 20 cm × 13 cm in the studied young child. It is obvious that individuals infected with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) are at an increased risk for lymphoproliferative and neoplastic disorders, including leiomyoma due to defective humoral and cellular immunity.[2] There is a close association between Epstein–Barr virus (EBV) infection and development of smooth muscle tumors, including leiomyoma in patients infected with HIV/AIDS.[3] To my knowledge, HIV infection is an important health threat in Brazil. Although no recent data are yet present on the exact pediatric seroprevalence of HIV infection in Brazil, the available data pointed out that the prevalence of HIV infection among pregnant women was reported to be 0.38%.[4] I presume that the vertically acquired HIV infection should be seriously considered in the studied child. Hence, the diagnostic battery of immunohistochemical stain and in situ hybridization technique for EBV-encoded ribonucleic acid tumor cell nuclei as well as viral overload and CD4 count measurements for HIV infection was envisaged. If that diagnostic battery was done and it revealed underlying EBV-HIV coinfection, the case in question could confidently broaden the spectrum of gastrointestinal leiomyoma associated with EBV-HIV coinfection rarely reported in the pediatric literature so far.[5]
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Conflicts of interest
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REFERENCES
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