Dear Editor,

In the May 2018 issue of the Oman Medical Journal, Bashir et al,1 published a report of an unusual case of an appendiceal inflammatory myofibroblastic tumor (IMT) in a Saudi patient who presented with symptoms and signs of acute appendicitis. The authors had properly described the clinical picture, imaging findings, histopathological and immunohistochemistry studies, and treatment plan. I presume that the rare occurrence of that tumor at an unusual site should alert the authors to take into consideration any underlying altered immune status. Among conditions associated with altered immune states, HIV infection is the leading cause. Individuals infected with HIV are more susceptible to various types of tumors compared to immune-competent individuals. The increased tumor susceptibility of HIV-positive individuals has been attributed to different factors including immunosuppression, coinfection with oncogenic viruses, and life prolongation secondary to the use of antiretroviral therapy.2 Though the prevalence of HIV in Saudi Arabia is low (0.05%) compared to other countries in the region and globally,3 the relative lake of awareness in general public knowledge of the disease, negative attitudes towards HIV/AIDS and infected persons, and limited contribution of health care professionals and educational institutions in providing the public with information about this health problem4 render HIV infection a potential health hazard in Saudi Arabia. Therefore, I presume that the authors had considered underlying HIV infection in the patient. Hence, a blood CD4 lymphocyte count and viral overload measurements would have been done. If the result revealed an underlying HIV infection, the case in question could be considered as the second novel case report of HIV-associated IMT. The first case was reported in a Romanian patient.5

references

1. 1. Bashir MR, Al Sohaibani MO, Al-Rikabi AC. An unusual case of inflammatory myofibroblastic tumor of the appendix masquerading as acute appendicitis. Oman Med J 2018 May;33(3):250-252.
2. 2. Valencia Ortega ME. Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases? Rev Clin Esp 2018 Apr;218(3):149-155.
3. 3. Filemban SM, Yasein YA, Abdalla MH, Al-Hakeem R, Al-Tawfiq JA, Memish ZA. Prevalence and behavioral risk factors for STIs/HIV among attendees of the Ministry of Health hospitals in Saudi Arabia. J Infect Dev Ctries 2015 Apr;9(4):402-408.
4. 4. Al-Ghanim SA. Exploring public knowledge and attitudes towards HIV/AIDS in Saudi Arabia. A survey of primary health care users. Saudi Med J 2005 May;26(5):812-818.
5. 5. Cambrea SC, Resul G, Bulbuc I, Cambrea M, Vasilescu F. Pulmonary inflammatory myofibroblastic tumor in an AIDS patient. Rom J Morphol Embryol 2014;55(2):407-412.