Effective anti-viral therapy for hemophagocytic syndrome associated with B-cell lymphoma.
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| Abstract |
A rheumatoid arthritis (RA) patient treated with low-dose methotrexate (MTX) therapy suffered from hemophagocytic syndrome (HPS) associated with B-cell lymphoma (B-LAHS). Administration of acyclovir and intravenous immunoglobulin promptly resolved laboratory test abnormalities accompanied with HPS. Moreover, hemophagocytic histiocytes and lymphoma cells in the bone marrow disappeared without anti-cancer therapy. Two months after reintroduction of MTX for RA flare, lymphoma re-grew rapidly without bone marrow involvement and HPS. Two cycles of combination chemotherapy induced the lymphoma to a complete remission/unconfirmed (CRu), but then the chemotherapy was discontinued due to severe side effects. In this case, on the basis of RA and MTX induced immunosuppressive state, Epstein-Barr virus (EBV) infection was associated with the development of HPS and lymphoma. Anti-viral therapy alone was effective against HPS and lymphoma at initial presentation and improved her general condition. This case indicates that anti-cancer therapy should be preceded by anti-viral therapy and withdrawal of immunosuppressive therapy in patients under immunosuppressive therapy, as long as the clinical situation permits.
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| Authors | Hiroshi Gomyo, Manabu Shimoyama, Kentaro Minagawa, Kimikazu Yakushijin, Norinaga Urahama, Atsuo Okamura, Katsuya Yamamoto, Mitsuhiro Ito, Kazuo Chihara, Toshimitsu Matsui |
| Journal | Leukemia & lymphoma (Leuk Lymphoma) Vol. 44 Issue 10 Pg. 1807-10 (Oct 2003) ISSN: 1042-8194 [Print] United States |
| PMID | 14692538 (Publication Type: Case Reports, Journal Article) |
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