Two children (ages 12 and 13 years) with transfusion-acquired human immunodeficiency virus (
HIV) infection presented with
facial pain and
rhinorrhea. Radiographic imaging showed extensive
paranasal sinus disease, presumed to be bacterial
sinusitis, and the patients were treated with broad-spectrum oral
antibiotics. Both patients were unresponsive to oral agents and were switched to intravenous
antibiotics. Despite aggressive antimicrobial
therapy, one patient (case 1) developed increased periorbital swelling and
proptosis, and the other patient (case 2) developed symptoms of nasopharyngeal obstruction. Repeat imaging showed progression of the infiltrative process extending from the paranasal sinuses into the orbit (case 1), and nasopharynx (case 2). Surgical exploration and tissue biopsies were performed on both patients and the histopathology was consistent with Burkitt's/Burkitt's-like
lymphoma. Combination systemic and intrathecal
chemotherapy resulted in a complete remission in both patients. These reports illustrate the fact that Burkitt's/Burkitt's-like
lymphoma in the paranasal sinuses may initially masquerade as an acute bacterial
sinusitis. The ability of the
tumor to extend rapidly from the sinuses into the orbit and nasopharynx reinforces the importance of early diagnosis and treatment. Burkitt's/Burkitt's-like
lymphoma in the paranasal sinuses has not been previously described in HIV-infected children.