International Journal of Hematology

, Volume 109, Issue 1, pp 125–129 | Cite as

Massive bone marrow necrosis revealing an HIV-related primary bone marrow lymphoma: a diagnostic challenge

  • Michael D. Diamantidis
  • Vasiliki Gogou
  • Triantafyllia Koletsa
  • Simeon Metallidis
  • Maria PapaioannouEmail author
Case Report


Bone marrow necrosis (BMN) is a condition that can be difficult to diagnose, requiring a hematologist experienced in bone marrow morphology. This diagnostic challenge should alert the clinician of a severe disease or a possible underlying malignancy, either hematological or a solid tumor. We describe the concomitant presence of a primary bone marrow lymphoma (diffuse large B-cell lymphoma—DLBCL), along with an extensive BMN in an HIV patient for the first time in a living individual. HIV infection, BMN and DLBCL presented a multifactorial crossword of molecular events underlying the complex pathophysiology. The exact precipitating pathophysiological events resulting in BMN remain obscure and provide their clear impact for future research. The present report is instructive and also contains a critical review of the literature related to the case presented.


Bone marrow necrosis (BMN) Human immunodeficiency virus (HIV) Primary bone marrow lymphoma Diffuse large B-cell lymphoma (DLBCL) Dismal prognosis 


Author contributions

MDD analyzed and interpreted data, performed literature review and wrote the manuscript; VG treated the patient, analyzed and interpreted data; TK analyzed and interpreted data and provided the pathology images of the bone marrow; SM treated the patient, performed literature review, analyzed and interpreted data; MP wrote and corrected the manuscript, was in charge of the overall study, diagnosed the bone marrow necrosis in the aspirate, treated the patient, analyzed and interpreted data and performed literature review.

Compliance with ethical standards

Conflict of interest

All authors declare they have no conflict of interest.

Informed consent

Because the case of a deceased patient is described, written informed consent from a close relative has been obtained.


  1. 1.
    Proskuryakov SY, Konoplyannikov AG, Gabai VL. Necrosis: a specific form of programmed cell death? Exp Cell Res. 2003;283:1–16.CrossRefGoogle Scholar
  2. 2.
    Proskuryakov SY, Gabai VL. Mechanisms of tumor cell necrosis. Curr Pharm Des. 2010;16:56–68.CrossRefGoogle Scholar
  3. 3.
    Delgado P, Giraldo P, Roca M, Alvarez R. Magnetic resonance imaging in the early diagnosis of bone marrow necrosis. Sangre (Barc). 1999;44:65–9.Google Scholar
  4. 4.
    Tang YM, Jeavons S, Stuckey S, Middleton H, Gill D. MRI features of bone marrow necrosis. AJR Am J Roentgenol. 2007;188:509–14.CrossRefGoogle Scholar
  5. 5.
    Kekilli E, Yagmur C, Kaya E, Kuku I, Ertem K, Aydogdu I. Decreased Tc-99m MDP uptake in myelonecrosis. Clin Nucl Med. 2006;31:33.CrossRefGoogle Scholar
  6. 6.
    Hanrahan CJ, Shah LM. MRI of spinal bone marrow: part 2, T1-weighted imaging-based differential diagnosis. AJR Am J Roentgenol. 2011;197:1309–21.CrossRefGoogle Scholar
  7. 7.
    Ozkan A, Ozkalemkas F, Ali R, Ozkocaman V, Ozcelik T. Severe bone marrow necrosis without suggestive features. Am J Hematol. 2006;81:386–7.CrossRefGoogle Scholar
  8. 8.
    Janssens AM, Offner FC, Van Hove WZ. Bone marrow necrosis. Cancer. 2000;88:1769–80.CrossRefGoogle Scholar
  9. 9.
    Wool GD, Deucher A. Bone marrow necrosis: ten-year retrospective review of bone marrow biopsy specimens. Am J Clin Pathol. 2015;143:201–13 (quiz 306).CrossRefGoogle Scholar
  10. 10.
    Badar T, Shetty A, Bueso-Ramos C, Cortes J, Konopleva M, Borthakur G, et al. Bone marrow necrosis in acute leukemia: clinical characteristic and outcome. Am J Hematol. 2015;90:769–73.CrossRefGoogle Scholar
  11. 11.
    Paydas S, Ergin M, Baslamisli F, Yavuz S, Zorludemir S, Sahin B, et al. Bone marrow necrosis: clinicopathologic analysis of 20 cases and review of the literature. Am J Hematol. 2002;70:300–5.CrossRefGoogle Scholar
  12. 12.
    Ishitsuka K, Shirahashi A, Iwao Y, Shishime M, Takamatsu Y, Takatsuka Y, et al. Bone marrow necrosis in a patient with acute promyelocytic leukemia during re-induction therapy with arsenic trioxide. Eur J Haematol. 2004;72:280–4.CrossRefGoogle Scholar
  13. 13.
    Rossi P, Curiel M, Demoux AL, Bagneres D, Costello R, Chaumoitre K, et al. Bone marrow necrosis and sickle cell crisis associated with double heterozygosity for HbS and HbOARAB. Am J Hematol. 2011;86:309–10.CrossRefGoogle Scholar
  14. 14.
    Miyoshi I, Daibata M, Ohtsuki Y, Taguchi H. Bone marrow necrosis. Br J Haematol. 2005;130:467.CrossRefGoogle Scholar
  15. 15.
    Giannoutsos I, Rosenfeld D. Bone marrow lipofuscin in a patient with acute myeloid leukaemia and extensive marrow necrosis. Br J Haematol. 2007;138:129.CrossRefGoogle Scholar
  16. 16.
    Taylor G, Ivey A, Milner B, Grimwade D, Culligan D. Acute myeloid leukaemia with mutated NPM1 presenting with extensive bone marrow necrosis and Charcot–Leyden crystals. Int J Hematol. 2013;98:267–8.CrossRefGoogle Scholar
  17. 17.
    Guinea JM, Menchaca C, Perez Clausell C, Aldamiz M. Marrow necrosis as the initial manifestation of a blast crisis in CML. Sangre (Barc). 1992;37:78–9.Google Scholar
  18. 18.
    Noguchi M, Oshimi K. Extensive bone marrow necrosis and symptomatic hypercalcemia in B cell blastic transformation of chronic myeloid leukemia: report of a case and review of the literature. Acta Haematol. 2007;118:111–6.CrossRefGoogle Scholar
  19. 19.
    Shapiro R, Rizkalla K, Lam S. Extensive bone marrow necrosis in a case of acute myeloid leukemia transformed from a myeloproliferative neoplasm. Case Rep Oncol. 2015;8:345–8.CrossRefGoogle Scholar
  20. 20.
    Moritake H, Obara M, Sameshima N, Asada Y, Komatsu H, Hyakuna N, et al. Analysis of the molecular mechanism underlying bone marrow necrosis with acute lymphoblastic leukemia. Int J Hematol. 2015;102:349–56.CrossRefGoogle Scholar
  21. 21.
    Hilal T, Bansal P, Kelemen K, Slack J. Nivolumab-associated bone marrow necrosis. Ann Oncol. 2018;29:513–4.CrossRefGoogle Scholar
  22. 22.
    Calore EE, Tanaka PY, Perez NM, de Almeida LV. Bone marrow pathology in AIDS. Pathol Res Pract. 2004;200:591–7.CrossRefGoogle Scholar
  23. 23.
    Ramraje SN, Ansari SAH, Kosale S. Diagnostic utility of bone marrow sampling and profile of hematological abnormalities in Indian HIV-infected individuals. Iran J Blood Cancer. 2016;8:117–22.Google Scholar
  24. 24.
    Rudresh K, Mukherjee T, Bhasin A, Modepalli N, Ahuja A. Bone marrow study in patients with human immune deficiency virus and acquired immune deficiency syndrome. Brunei Int Med J. 2011;7:148–56.Google Scholar
  25. 25.
    Cosby CD. Hematologic disorders associated with human immunodeficiency virus and AIDS. J Infus Nurs. 2007;30:22–32.CrossRefGoogle Scholar
  26. 26.
    Kotwal J, Singh V, Kotwal A, Dutta V, Nair V. A study of haematological and bone marrow changes in symptomatic patients with human immune deficiency virus infection with special mention of functional iron deficiency, anaemia of critically ill and haemophagocytic lymphohistiocytosis. Med J Armed Forces India. 2013;69:319–25.CrossRefGoogle Scholar
  27. 27.
    Jacomet C, Lesens O, Villemagne B, Darcha C, Tournilhac O, Henquell C, et al. Non Hodgkin’s and Hodgkin’s lymphomas and HIV: frequency, outcome and immune response under HAART; Clermont-Ferrand University Hospital, 1991–2003. Med Mal Infect. 2006;36:157–62.CrossRefGoogle Scholar
  28. 28.
    Hishizawa M, Okamoto K, Chonabayashi K, Kaneko H, Watanabe M, Tsudo M. Primary large B-cell lymphoma of the bone marrow. Br J Haematol. 2007;136:351.CrossRefGoogle Scholar
  29. 29.
    Shah BK, Subramaniam S, Peace D, Garcia C. HIV-associated primary bone marrow Hodgkin’s lymphoma: a distinct entity? J Clin Oncol. 2010;28:e459–60.CrossRefGoogle Scholar
  30. 30.
    Casassus P, Roulot D, Le Roux G, Eclache V, Lortholary P, Hutin Y, et al. Lymphomatous bone marrow necrosis in a case of AIDS. Ann Med Internet (Paris). 1990;141:476–8.Google Scholar

Copyright information

© The Japanese Society of Hematology 2018

Authors and Affiliations

  1. 1.Department of Haematology, First Department of Internal Medicine, Faculty of Medicine, AHEPA General HospitalAristotle University of Thessaloniki (AUTH)ThessalonikiGreece
  2. 2.Department of Pathology, Faculty of Medicine, AHEPA General HospitalAristotle University of Thessaloniki (AUTH)ThessalonikiGreece

Personalised recommendations