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

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...

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Autores principales: Kakiuchi, Seiji, Yakushijin, Kimikazu, Takagi, Ikumi, Rikitake, Junpei, Akiyama, Hiroaki, Matsuba, Hiroyuki, Hayashi, Yoshitake, Kajimoto, Kazuyoshi, Iwata, Nobuko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785868/
https://www.ncbi.nlm.nih.gov/pubmed/33425968
http://dx.doi.org/10.3389/fmed.2020.625442
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author Kakiuchi, Seiji
Yakushijin, Kimikazu
Takagi, Ikumi
Rikitake, Junpei
Akiyama, Hiroaki
Matsuba, Hiroyuki
Hayashi, Yoshitake
Kajimoto, Kazuyoshi
Iwata, Nobuko
author_facet Kakiuchi, Seiji
Yakushijin, Kimikazu
Takagi, Ikumi
Rikitake, Junpei
Akiyama, Hiroaki
Matsuba, Hiroyuki
Hayashi, Yoshitake
Kajimoto, Kazuyoshi
Iwata, Nobuko
author_sort Kakiuchi, Seiji
collection PubMed
description 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.
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spelling pubmed-77858682021-01-07 Case Report: Composite Angioimmunoblastic T-Cell Lymphoma and Epstein-Barr Virus-Positive B-Cell Lymphoproliferative Disorder as Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders Kakiuchi, Seiji Yakushijin, Kimikazu Takagi, Ikumi Rikitake, Junpei Akiyama, Hiroaki Matsuba, Hiroyuki Hayashi, Yoshitake Kajimoto, Kazuyoshi Iwata, Nobuko Front Med (Lausanne) Medicine 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. Frontiers Media S.A. 2020-12-23 /pmc/articles/PMC7785868/ /pubmed/33425968 http://dx.doi.org/10.3389/fmed.2020.625442 Text en Copyright © 2020 Kakiuchi, Yakushijin, Takagi, Rikitake, Akiyama, Matsuba, Hayashi, Kajimoto and Iwata. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Kakiuchi, Seiji
Yakushijin, Kimikazu
Takagi, Ikumi
Rikitake, Junpei
Akiyama, Hiroaki
Matsuba, Hiroyuki
Hayashi, Yoshitake
Kajimoto, Kazuyoshi
Iwata, Nobuko
Case Report: Composite Angioimmunoblastic T-Cell Lymphoma and Epstein-Barr Virus-Positive B-Cell Lymphoproliferative Disorder as Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders
title Case Report: Composite Angioimmunoblastic T-Cell Lymphoma and Epstein-Barr Virus-Positive B-Cell Lymphoproliferative Disorder as Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders
title_full Case Report: Composite Angioimmunoblastic T-Cell Lymphoma and Epstein-Barr Virus-Positive B-Cell Lymphoproliferative Disorder as Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders
title_fullStr Case Report: Composite Angioimmunoblastic T-Cell Lymphoma and Epstein-Barr Virus-Positive B-Cell Lymphoproliferative Disorder as Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders
title_full_unstemmed Case Report: Composite Angioimmunoblastic T-Cell Lymphoma and Epstein-Barr Virus-Positive B-Cell Lymphoproliferative Disorder as Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders
title_short Case Report: Composite Angioimmunoblastic T-Cell Lymphoma and Epstein-Barr Virus-Positive B-Cell Lymphoproliferative Disorder as Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders
title_sort case report: composite angioimmunoblastic t-cell lymphoma and epstein-barr virus-positive b-cell lymphoproliferative disorder as other iatrogenic immunodeficiency-associated lymphoproliferative disorders
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785868/
https://www.ncbi.nlm.nih.gov/pubmed/33425968
http://dx.doi.org/10.3389/fmed.2020.625442
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