Case 16-2014: a 46-year-old woman in Botswana with postcoital bleeding

Abstract

In Botswana, limited specialized oncologic services are available in the face of a rising burden of cancer. A collaborative outreach program between doctors at MGH and in Botswana was established in 2011 to build the capacity to deliver quality cancer care in Botswana. A goal of the outreach program was the creation of a multidisciplinary tumor board, which involves physicians in Botswana and physicians based at MGH and Harvard Medical School who have expertise in a variety of cancer-related fields. The tumor board discussed this patient’s case by telephone-based and Internet-based conferencing and helped to develop the treatment plan. This 46-year-old HIV infected woman presented after 10 months of recurrent postcoital bleeding. Other symptoms included intermittent urinary frequency, dysuria, pelvic pain, vaginal discharge, and pruritus. She had had two Pap tests, 3 years apart, with the results showing low-grade and high-grade squamous intraepithelial lesions. She had been receiving treatment for HIV for approximately 4 years, with virologic suppression and good CD4+ T-cell recovery. This patient received chemoradiation followed by intravaginal brachytherapy and had a complete clinical response, with no palpable tumor. No changes were made to her ART and no nephrotoxic effects were detected. Diarrhea and mild vaginal stenosis developed during the course of therapy. One year after completing treatment, she remained in remission, without any pain, and was able to resume normal sexual activity.