Unexplained systemic symptoms and Gallium-67--guided decisions.

Abstract

Over 3 months, a healthy man developed prominent systemic symptoms that defied investigation. Physical examination was noncontributory, and extensive studies revealed only a marked acute-phase response associated with increased serum IL-6 levels. A whole body Gallium-67 scan was crucial in diagnosis, directing attention to high uptake in the left paraspinal and psoas muscles. Open surgical excision biopsy was performed, guided by intraoperative use of a gamma-probe. Removed tissue was diagnosed as diffuse, large B-cell non-Hodgkin lymphoma of muscle (stage IE), a rare extranodal lymphoma. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy was given, and the patient became asymptomatic with normal blood tests and was thought to be in remission. However, a repeat Gallium-67 scan revealed recurrent multifocal disease and salvage chemotherapy was instituted. A 47,XXY karyotype (Klinefelter syndrome) was later identified, possibly associated with the lymphoma.

• Authors: A Schattner, A Cohen, L Wolfson, M Melloul
• Journal: The American journal of the medical sciences (Am J Med Sci) Vol. 321 Issue 3 Pg. 198-200 (Mar 2001) ISSN: 0002-9629 [Print] United States
• PMID: 11269797 (Publication Type: Case Reports, Journal Article)

Chemical References

• Gallium Radioisotopes
• Interleukin-6

Topics

• Agriculture
• Diagnosis, Differential
• Gallium Radioisotopes
• Humans
• Interleukin-6 (blood)
• Lymphoma, B-Cell (diagnosis, surgery)
• Lymphoma, Non-Hodgkin (diagnosis, surgery)
• Male
• Middle Aged
• Muscle Neoplasms (diagnosis, surgery)
• Psoas Muscles (pathology, surgery)
• Radionuclide Imaging
• Workforce