Azathioprine
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Hepatosplenic γδ T-cell lymphoma: case report
A 51-year-old man developed hepatosplenic γδ T-cell lymphoma (HSTCL) during treatment with azathioprine for ulcerative colitis (UC). The man, who was diagnosed with UC of the rectum 17 years previously, had been receiving treatment with azathioprine [route and dosage not stated]. He developed several flare-ups of bowel disease until 2014 when his disease stabilised. During a routine check-up in May 2018, bicytopenia (grade 4 neutropenia and grade 2 thrombocytopenia) was observed. These cytopenias were firstly attributed to azathioprine toxicity, resulting in discontinuation of the drug. A month afterwards, the man presented to the emergency department with fever and abdominal pain. He was sweating, depressed and dyspnoeic. He had a weight loss of 5–6kg in 6 months. In light of this worrying, but not very specific clinical picture, he was hospitalised for further tests. A CT scan did not show the presence of focal lesions in the abdominal area. Ultrasound showed normal echogenicity and a homogeneous appearance of the liver, as well as a splenomegaly at 17cm. Owing to the absence of improvement in the cytopenias despite cessation of azathioprine, he underwent a bone marrow biopsy and aspiration. This showed dysplasia of the three hematopoietic cell lines, in which there was a large population of blast-like cells, sometimes finely granular, heterogeneous in size, with fine chromatin revealing one or more nucleoli. Immunophenotyping showed that these cells were CD34-, CD3+, CD4-, CD8-, CD5-, CD2+, CD7+, CD56+ (partial), CD16+ and express the gamma delta T-cell receptor (γδ TCR). A histobiochemical assay showed the presence of abundant cell infiltrate, often sinusoidal, EBV-negative T-cells, expressing the TIA1 protein, and very indicative of a lymphoproliferative process with a T-cell or NK/T-cell phenotype. Molecular biology demonstrated the presence of a T-type monoclonal rearrangement. All of this data pointed towards a diagnosis of stage IV non-Hodgkin’s γδ T-cell/NK lymphoma. A positron emission tomography (PET) scan confirmed diffuse bone marrow metastasis, as well as splenic nodule hypercaptation, and the diagnosis of HSTCL [duration of treatment to reaction onset not stated] was retained. He was treated according to the induction regimen with ifosfamide, cytarabine, etoposide (IVAC) over 5 days, and with a neuromeningeal prophylaxis using methylprednisolone and methotrexate. Two IVAC cycles were scheduled and an intermediate assessment after the 2 courses demonstrated a complete response in the PET scan. After a total of four IVAC cycles with a complete response, he underwent a familial haematopoietic allogeneic stem cell transplant. Lambert B, et al. Blastic morphology of a hepatosplenic T cell lymphoma in a patient treated by immunosuppressive drugs for ulcerative colitis. [French]. Hematologie 26: 50-56, No. 1, Jan-Feb 2020. Available from: URL: https://www.jle.com/en/revues/hma/sommaire.phtml?cle_parution=4878 [French; summarised from a 803499192 translati
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