Long-term survival following metachronous intratumoral hemorrhage in an HIV-infected patient with lung cancer.

Human immunodeficiency virus (HIV)-infected patients are likely to develop intracranial events. Due to the spread of highly active antiretroviral therapy (HAART), HIV-infected patients now survive longer, and metastatic non-AIDS-defining carcinoma is increasing. A 49-year-old man with HIV infection undergoing treatment with HAART developed an intratumoral hemorrhage in the right frontal lobe. He was diagnosed as having lung adenocarcinoma and was found to have a brain metastasis with bleeding. After treatment for intratumoral bleeding, a contralateral frontal lobe hemorrhage occurred within a month. The patient underwent a second craniotomy and removal of hematoma, followed by whole-brain radiotherapy. He was then treated with four cycles of cisplatin and gemcitabine combination chemotherapy while receiving HAART. A partial response was achieved, though he developed severe hematological toxicities for which the doses of chemotherapy needed to be decreased. However, as a result of treatment, his activities of daily life recovered gradually. This lung cancer patient had been alive for 17 months despite the coexistence of two disorders with a poor prognosis, HIV infection and bleeding brain metastases from lung cancer. This case revealed that physicians must include non-AIDS-defining cancer metastasis to the brain in the differential diagnosis of HIV-infected patients when they show stroke-like symptoms, and such patients may respond to treatment as well as non-HIV-infected patients with advanced lung cancer.