A clinical case is presented: a 34-year-old female patient, partner of an addict, with two HIV-negative children. Positive since 1995, she declares herself to be single and a housewife. She presented for consultation on an outpatient basis in early March 2005. On admission, she was negative for VDRL, Chagas, Toxoplasmosis, Hepatitis B surface antigen and positive for Hepatitis C and Cytomegalovirus (CMV). The CD4+ cell count at that time was 125 cells/dl (4%), with the viral load result in the pipeline. An antiretroviral treatment regimen of D4T, 3TC and EFAVIRENS was established.
The patient returned after 45 days reporting significant weight loss, night sweats and a non-painful nodule at the level of the right upper incisor, according to medical description. Hospitalisation was indicated.
A routine blood test showed a haematocrit of 32%, haemoglobin of 10 and white blood cells of 3,800. Medication had been discontinued due to intolerance.
On inspection by a stomatologist, the report stated that the patient did not present oral candidiasis or odynophagia, but three evolving lesions were observed: one at the level of the upper right canine, nodular, involving part of the tooth inside, painful and bright red in colour, continuing distally and extending towards the palate. In the posterior area, an ulcer with everted edges, with a necrotic base, extended to the posterior area of the molars. These three lesions evolved day by day, taking on greater proportions and including the soft parts of the facial region.

On general observation, the abdomen was soft and painless. A new blood test showed a haematocrit of 275, haemoglobin of 9.3% and white blood cells: 8,100; platelets: 237,000. The patient's evolution shows signs of failure, without fever. Doppler ultrasound and CT angiography were performed.
Three biopsies were taken of the buccal tumour which had advanced along the alveolar ridge towards the posterior hamular area and the hard and soft palate on the same side. An ulcer measuring 2 cm long by 1.5 cm wide was located on the alveolar ridge in the molar area and in the incisal area, a cone-shaped protuberance with a base of approximately 2 cm in diameter was implanted on the anterior alveolar ridge and its ulcerated end hatched outwards, with signs of disordered inclusion of 2 teeth.

The histological report of the oral lesions reported "a morphologically lymphoid cellular proliferation consisting of small to large cells with two or more vesicular nuclei and obvious eosinophilic nucleoli. Numerous mitotic figures with a high proliferation index, immunoblastic large cell type, are observed.
On immunohistochemical staining the report stated "B cells and positive labelling for CD 79, CD209, and CD22 antigens. The tumour cells are negative for epithelial markers CD56, CD57, CD50 and CD15. Diffuse histiocytic large cell lymphoma".
The oncology team started the first course of ERORH (prednisone+etoposide+ dexamethasone+ cyclophosphamide + vincristine). Dose adjusted to CD4 > 100. Postoperatively, the patient developed neutropenia, fever, oral candidiasis and active perianal herpes virus lesion.
The second cycle of chemotherapy was started and she progressed with general improvement, without complications. The patient was discharged on 14/6/05 with indications to treat CMV and with the installation of antiretroviral treatment (ART) with D4T, EFV and -3TC.
The patient returned with a very poor general condition and was re-admitted. A new magnetic resonance imaging study revealed multiple nodular images in the liver and kidney, compatible with lymphoma. In addition, reactivation of anal herpes virus, very painful, for which she was medicated with Acyclovir 800 mg daily and Amphotericin B + TMS at PCP doses.
The oro-facial non-Hodgkin's lymphoma, diagnosed as highly malignant, had already involved the entire right hemifacial area and showed greater proportions of invasion, which was already painful. On daily inspection, signs of the same disease were diagnosed in the intra-abdominal area and the pericardium. There was a deterioration of the general condition with persistent vomiting and nausea, generalised pain, prostration, oral and oesophageal candidiasis and on 6/9/05, the patient obitated, febrile neutropenic, six months after her first consultation.

