Abstract
Here we present a 40-yr-old male patient with an aggressive B-cell lymphoma, who presented 2 yr earlier with polyarthritis, and was responsive to steroids and oral methotrexate. Thereafter he developed skin and lung lesions which on biopsy consisted of mixed 'inflammatory' infiltrates with granulomatous vasculitis. A diagnosis of seronegative Wegener's granulomatosis was made and the patient received a combination of prednisone and cyclophosphamide with clinical improvement and clearance of the radiological lesions in the lungs. The patient was now completely asymptomatic for 1 yr, but then generalized lymphadenopathy appeared, which was shown by histopathology to be large B-cell lymphoma, also involving the bone marrow. Despite intensive chemotherapy, his disease could not be controlled because of primary chemoresistance, which was perhaps in some way related to exposure to the suboptimal doses of chemotherapy given during the 'inflammatory' period before the diagnosis of lymphoma was established. This case illustrates the occasional difficulty in distinguishing between extranodal lymphoproliferative diseases and autoimmune disorders especially when clonality cannot be proved. It also shows the possible risk of 'masking' a tru...Continue Reading
References
Mar 15, 1992·Annals of Internal Medicine·G S HoffmanA S Fauci
Jun 1, 1991·Thorax·J H SmallA D Ferguson
May 1, 1983·Archives of Dermatology·M C Finan, R K Winkelmann
Feb 1, 1995·Leukemia & Lymphoma·N A PavlidisH M Moutsopoulos
Apr 1, 1994·Journal of Endocrinological Investigation·J GochuL Poretsky
Jan 1, 1993·Nephron·P GratadourP Zech
Feb 17, 1993·Journal of the National Cancer Institute·G GridleyJ F Fraumeni
Oct 1, 1996·Seminars in Arthritis and Rheumatism·M D Wooten, H E Jasin
Jul 17, 1998·BMJ : British Medical Journal·E BaecklundL Klareskog
May 8, 1999·Clinical and Experimental Dermatology·A M FarrellJ J Cream
Sep 9, 1999·Journal of Clinical Gastroenterology·A Tursi, G Gasbarrini
Nov 2, 1999·Medizinische Klinik·M BohleA Fisseler-Eckhoff
Aug 5, 2000·Oral Diseases·C M Allen, C Camisa
Aug 24, 2001·Internal Medicine·N MiyaharaM Harada
Jan 25, 2002·Journal of the American Academy of Dermatology·Jens GilleRoland Kaufmann
Jul 13, 2002·International Journal of Cancer. Journal International Du Cancer·Ann KnightAnders Ekbom
Nov 12, 2002·Rheumatology International·László VáróczyArpád Illés
Feb 18, 2003·Virchows Archiv : an International Journal of Pathology·A SaxenaD W Cockroft
Feb 25, 2003·Lancet·Imre NothAlan R Leff
Mar 29, 2003·Journal of the American Academy of Dermatology·Ilene B Bayer-Garner, Bruce R Smoller
Apr 11, 2003·Arthritis and Rheumatism·Dimitrios VassilopoulosGary S Hoffman
Citations
Jan 24, 2006·Clinical Rheumatology·Shuang Ye, Cheng-de Yang
Jun 4, 2013·Clinical Rheumatology·Geewon LeeMan Pyo Chung
Dec 1, 2011·Clinical Journal of Gastroenterology·Hiromichi YamaneKatsuyuki Kiura
Sep 27, 2006·Clinical and Laboratory Haematology·L AiraghiL Baldini
Apr 11, 2015·Wiener klinische Wochenschrift·Serkan GuneyliHudaver Alper
Jun 14, 2016·Case Reports in Rheumatology·Mohammad E NaffaaAlexandra Balbir-Gurman
Jun 14, 2008·Journal of the American Academy of Dermatology·Julia M KwanDamian P Derienzo
Mar 15, 2005·Clinical Nuclear Medicine·Veronica SolisRichard P Spencer