Case Report: Composite Angioimmunoblastic T-Cell Lymphoma and Epstein-Barr Virus-Positive B-Cell Lymphoproliferative Disorder as Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders

Frontiers in Medicine

Hiroyuki Matsuba¹  Nobuko Iwata¹  Ikumi Takagi¹  Hiroaki Akiyama¹  Junpei Rikitake²  Seiji Kakiuchi²  Kazuyoshi Kajimoto³  Kimikazu Yakushijin⁴  Yoshitake Hayashi⁵ 

[1] Department of Hematology, Yodogawa Christian Hospital, Osaka, Japan;Department of Hematology, Yodogawa Christian Hospital, Osaka, Japan;Division of Medical Oncology and Hematology, Kobe University Graduate School of Medicine, Kobe, Japan;Department of Pathology, Hyogo Cancer Center, Akashi, Japan;Division of Medical Oncology and Hematology, Kobe University Graduate School of Medicine, Kobe, Japan;Division of Molecular Medicine & Medical Genetics, Department of Pathology, Kobe Graduate School of Medicine, Kobe, Japan;

关键词: composite lymphoma;    Epstein-Barr virus reactivation;    methotrexate;    angioimmunoblastic T-cell lymphoma (AITL);    clonal expansion;   

DOI  :  10.3389/fmed.2020.625442

来源: Frontiers

【 摘 要 】

Immunosuppressants are widely used to treat patients with rheumatoid arthritis (RA), and their adverse effects have been known to cause other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPDs). We report a patient with RA who had been treated with methotrexate (MTX) and tacrolimus (TAC) and who developed whole body lymphadenopathy. We simultaneously confirmed angioimmunoblastic T-cell lymphoma (AITL) through a right cervical lymph node biopsy and Epstein-Barr virus-positive B-cell lymphoproliferative disorder (EBV-positive B-LPD) through a bone marrow examination. After cessation of immunosuppressant therapy, both LPDs completely disappeared. Patients with AITL are occasionally reported to develop B-cell lymphoma through reactivation of the EBV, which leads to clonal expansion in the microenvironment. Immunohistochemistry results revealed that both LPD components were positive for EBV-encoded RNA. Moreover, in this patient, the plasma EBV DNA level was found to be high; therefore, EBV infection was a probable etiology. Synchronous coexistence of AITL and B-LPD as an OIIA-LPD has rarely been reported. This case report is the first to discuss the disappearance of both LPDs on withdrawal of immunosuppressants only. AITL occasionally accompany B-LPD; however, this composite lymphoma comprised AITL and B-LPD, and OIIA-LPDs should not be overlooked.

【 授权许可】

CC BY