# A Case of Life-Threatening Airway Obstruction Due to Epstein-Barr Virus–Associated Smooth Muscle Tumor With HIV Infection

## TL;DR

A rare Epstein-Barr virus-associated smooth muscle tumor caused life-threatening airway obstruction in a woman with HIV, requiring emergency treatment.

## Contribution

This case highlights the potential severity of EBV-SMT in HIV patients and emphasizes the need for timely multidisciplinary care.

## Key findings

- The patient required emergency tracheostomy due to airway obstruction from EBV-SMT.
- Multiple EBV-SMT lesions were found in the patella, vertebra, and upper glottis.
- The patient remained recurrence-free for over 3 years after surgical resection.

## Abstract

Epstein-Barr virus–associated smooth-muscle tumor (EBV-SMT) is a rare tumor that occurs in immunosuppressed individuals. Among people living with human immunodeficiency virus (HIV), opportunistic infections are more likely to determine prognosis than EBV-SMT itself. Herein, we describe a patient with HIV whose airway became obstructed due to one of the multiple tumor nodules of EBV-SMT. This 36-year-old woman living with advanced HIV presented with sudden dyspnea. On presentation, she experienced respiratory failure due to airway obstruction, requiring an emergency tracheostomy. Examinations revealed multiple lesions in the right patella, 12th thoracic vertebra, and upper glottis, all diagnosed as EBV-SMT. Despite antiretroviral therapy, surgical interventions were required for disease control. She has remained recurrence free for >3 years after resection. Although EBV-SMT is generally considered an indolent tumor, this case demonstrates that it can cause life-threatening complications, for which a timely multidisciplinary team approach is most crucial.