Botryoid Rhabdomyosarcoma of the Conjunctiva in a Young Boy.

Sir,

I read with interest the case report by Pennington et al.[1] on the botryoid rhabdomyosarcoma (RMS) of the conjunctiva in a 5-year-old Asian boy. The authors interestingly described the clinical picture and imaging, histopathologic, and molecular findings as well as the treatment plan in the studied patient. I presume that the aggressive nature of the tumor on one side and its rare occurrence at an unusual site on the other side should trigger the authors to consider defective immune status in the studied patient. Among defective immune states, human immunodeficiency virus (HIV) infection is prioritized. My presumption is based on the following point. It is obvious that individuals infected with HIV are more vulnerable to various kinds of tumors compared to healthy individuals. The increased vulnerability has been suggested to be due to different factors, including immune deficiency, associated infection with oncogenic viruses, and life extension due to the use of antiretroviral treatment.[2] Among tumors, RMS has been reported in HIV-positive patients.[3] Asia represents one of the few regions globally where there is a continued increase in the incidence of HIV infection.[4] I, therefore, presume that some sort of vertical HIV transmission from the mother to the child ought to be seriously considered. Hence, determining HIV status in the studied boy and his mother through the diagnostic panel of blood CD4 lymphocyte count and viral overload measurements was envisaged. If that panel was to reveal HIV infection, the case in question could be surely regarded the second novel case report of pediatric HIV-associated orbital RMS. The first case was reported in a Malaysian child published a decade ago.[5]

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