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Secondary Gamma-Delta T-Cell Lymphoma Not Otherwise Specified (NOS) From Chronic Immunosuppression

Herein, we present the case of a 63-year-old female with a history of Behçet’s disease managed with long-term prednisone and azathioprine who initially presented for symptomatic anemia, which progressed to pancytopenia with neutropenic fever. Initial workup ruled out infectious etiologies but was in...

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Autores principales: Turcotte, Madeleine E, Kelkar, Amar H, Chaffin, Joanna, Dang, Nam H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169379/
https://www.ncbi.nlm.nih.gov/pubmed/34094764
http://dx.doi.org/10.7759/cureus.14808
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author Turcotte, Madeleine E
Kelkar, Amar H
Chaffin, Joanna
Dang, Nam H
author_facet Turcotte, Madeleine E
Kelkar, Amar H
Chaffin, Joanna
Dang, Nam H
author_sort Turcotte, Madeleine E
collection PubMed
description Herein, we present the case of a 63-year-old female with a history of Behçet’s disease managed with long-term prednisone and azathioprine who initially presented for symptomatic anemia, which progressed to pancytopenia with neutropenic fever. Initial workup ruled out infectious etiologies but was indeterminate for immune-mediated or neoplastic causes. Bone marrow biopsy demonstrated a CD8+ gamma-delta T-cell neoplasm; however, imaging and skin biopsy pathology did not support hepatosplenic or cutaneous lymphoma involvement. By the 2017 World Health Organization (WHO) classifications, these findings were defined as gamma-delta peripheral T-cell lymphoma, not otherwise specified (NOS). This is suspected to be secondary to chronic immunosuppression from long-term steroid and azathioprine use. The patient was treated with one cycle of the EPOCH chemotherapy regimen ((etoposide, vincristine, cyclophosphamide, doxorubicin, and prednisone), but the treatment course was complicated by an angioinvasive fungal infection and the patient subsequently transitioned to symptom-focused therapy in a hospice facility.
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spelling pubmed-81693792021-06-04 Secondary Gamma-Delta T-Cell Lymphoma Not Otherwise Specified (NOS) From Chronic Immunosuppression Turcotte, Madeleine E Kelkar, Amar H Chaffin, Joanna Dang, Nam H Cureus Oncology Herein, we present the case of a 63-year-old female with a history of Behçet’s disease managed with long-term prednisone and azathioprine who initially presented for symptomatic anemia, which progressed to pancytopenia with neutropenic fever. Initial workup ruled out infectious etiologies but was indeterminate for immune-mediated or neoplastic causes. Bone marrow biopsy demonstrated a CD8+ gamma-delta T-cell neoplasm; however, imaging and skin biopsy pathology did not support hepatosplenic or cutaneous lymphoma involvement. By the 2017 World Health Organization (WHO) classifications, these findings were defined as gamma-delta peripheral T-cell lymphoma, not otherwise specified (NOS). This is suspected to be secondary to chronic immunosuppression from long-term steroid and azathioprine use. The patient was treated with one cycle of the EPOCH chemotherapy regimen ((etoposide, vincristine, cyclophosphamide, doxorubicin, and prednisone), but the treatment course was complicated by an angioinvasive fungal infection and the patient subsequently transitioned to symptom-focused therapy in a hospice facility. Cureus 2021-05-02 /pmc/articles/PMC8169379/ /pubmed/34094764 http://dx.doi.org/10.7759/cureus.14808 Text en Copyright © 2021, Turcotte et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Oncology
Turcotte, Madeleine E
Kelkar, Amar H
Chaffin, Joanna
Dang, Nam H
Secondary Gamma-Delta T-Cell Lymphoma Not Otherwise Specified (NOS) From Chronic Immunosuppression
title Secondary Gamma-Delta T-Cell Lymphoma Not Otherwise Specified (NOS) From Chronic Immunosuppression
title_full Secondary Gamma-Delta T-Cell Lymphoma Not Otherwise Specified (NOS) From Chronic Immunosuppression
title_fullStr Secondary Gamma-Delta T-Cell Lymphoma Not Otherwise Specified (NOS) From Chronic Immunosuppression
title_full_unstemmed Secondary Gamma-Delta T-Cell Lymphoma Not Otherwise Specified (NOS) From Chronic Immunosuppression
title_short Secondary Gamma-Delta T-Cell Lymphoma Not Otherwise Specified (NOS) From Chronic Immunosuppression
title_sort secondary gamma-delta t-cell lymphoma not otherwise specified (nos) from chronic immunosuppression
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169379/
https://www.ncbi.nlm.nih.gov/pubmed/34094764
http://dx.doi.org/10.7759/cureus.14808
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