BACKGROUND: Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is a rare neoplasm that predominantly occurs in immunocompromised individuals, including patients with advanced human immunodeficiency virus (HIV) infection. Endobronchial involvement is exceptionally uncommon and can present significant diagnostic challenges.

CASE REPORT: A 48-year-old woman with newly diagnosed advanced HIV infection (CD4 count: 2 cells/μL) presented with a 2-year history of progressive dyspnea. Imaging revealed a left endobronchial mass causing complete atelectasis of the left lung, accompanied by bilateral adrenal and hepatic masses. Bronchoscopic resection was performed to relieve airway obstruction. Histopathological examination demonstrated a spindle cell tumor with smooth muscle differentiation, and Epstein-Barr virus-encoded RNA in situ hybridization confirmed the diagnosis of EBV-SMT. Despite transient clinical improvement following bronchoscopic intervention and initiation of antiretroviral therapy, the patient’s course was complicated by recurrent severe infections and rapid clinical deterioration, precluding definitive oncologic treatment.

CONCLUSIONS: This case highlights the rare presentation of EBV-SMT as an endobronchial lesion in a profoundly immunocompromised patient. EBV-SMT should be considered in the differential diagnosis of endobronchial spindle cell tumors in such settings. Accurate diagnosis requires histopathological evaluation with EBV confirmation. Management remains challenging and often centers on local tumor control and immune reconstitution.

Keywords: Case Reports, Epstein-Barr Virus Infections, HIV Infections, Immunocompromised Host, Neoplasms, Muscle Tissue, oncology