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Epstein-Barr virus-negative, CD5-positive diffuse large B-cell lymphoma developing after treatment with oral tacrolimus for mixed connective tissue disease : a case report and review of the literature.
- Source :
-
Journal of clinical and experimental hematopathology : JCEH [J Clin Exp Hematop] 2012; Vol. 52 (3), pp. 211-8. - Publication Year :
- 2012
-
Abstract
- A 69-year-old woman, who had been diagnosed as having Sjögren's syndrome at 37 years old and mixed connective tissue disease at 42 years old, was under treatment with oral prednisolone. In 2009, she was diagnosed as having active systemic lupus erythematosus, and started on treatment with tacrolimus at 3 mg/day. In 2010, para-aortic lymphadenopathy and superficial multiple lymphadenopathy were detected. Tacrolimus was discontinued. Axillary lymph node biopsy revealed Epstein-Barr (EB) virus-negative CD5-positive diffuse large B-cell lymphoma (DLBCL). The patient was classified into clinical stage IIIA and as being at high risk according to the international prognostic index. After the discontinuation of tacrolimus, the lymph nodes reduced temporarily in size. In January 2011, the lymphadenopathy increased again, and the patient received a total of 8 courses of therapy with rituximab, pirarubicin, vincristine, cyclophosphamide and prednisolone, followed by intrathecal injection to prevent central nervous system infiltration, which was followed by complete remission. In February 2012, fluorodeoxyglucose positron emission tomography showed relapse in multiple lymph nodes and central nervous system infiltration. The patient was considered to have iatrogenic lymphoproliferative disorder classified as "other iatrogenic immunodeficiency-associated lymphoproliferative disorders" by the WHO, and this is the first reported case of CD5-positive DLBCL and central nervous system infiltration following administration of the drug. The patient was considered to have a poor prognosis as EB virus was negative, discontinuation of tacrolimus was ineffective and there was evidence of central nervous system infiltration.
- Subjects :
- Aged
Antibodies, Monoclonal, Murine-Derived administration & dosage
CD5 Antigens genetics
CD5 Antigens immunology
Cyclophosphamide administration & dosage
Doxorubicin administration & dosage
Doxorubicin analogs & derivatives
Female
Herpesvirus 4, Human
Humans
Iatrogenic Disease
Lupus Erythematosus, Systemic complications
Lupus Erythematosus, Systemic drug therapy
Lupus Erythematosus, Systemic immunology
Lymphoma, Large B-Cell, Diffuse drug therapy
Lymphoma, Large B-Cell, Diffuse etiology
Lymphoma, Large B-Cell, Diffuse immunology
Mixed Connective Tissue Disease complications
Mixed Connective Tissue Disease drug therapy
Mixed Connective Tissue Disease immunology
Prednisolone administration & dosage
Rituximab
Sjogren's Syndrome complications
Sjogren's Syndrome drug therapy
Sjogren's Syndrome immunology
Vincristine administration & dosage
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Immunosuppressive Agents adverse effects
Lupus Erythematosus, Systemic pathology
Lymphoma, Large B-Cell, Diffuse pathology
Mixed Connective Tissue Disease pathology
Sjogren's Syndrome pathology
Tacrolimus adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1880-9952
- Volume :
- 52
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of clinical and experimental hematopathology : JCEH
- Publication Type :
- Academic Journal
- Accession number :
- 23269082
- Full Text :
- https://doi.org/10.3960/jslrt.52.211