Effective anti-viral therapy for hemophagocytic syndrome associated with B-cell lymphoma.
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.
Gomyo
Hiroshi
H
Hematology/Oncology, Department of Medicine, Kobe University School of Medicine, Chuo-ku, Kobe 650-0017, Japan. gomyo@med.kobe-u.ac.jp
Shimoyama
Manabu
M
Minagawa
Kentaro
K
Yakushijin
Kimikazu
K
Urahama
Norinaga
N
Okamura
Atsuo
A
Yamamoto
Katsuya
K
Ito
Mitsuhiro
M
Chihara
Kazuo
K
Matsui
Toshimitsu
T
D000212:Acyclovir / Q000627:therapeutic use*; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D015616:Histiocytosis, Non-Langerhans-Cell / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016393:Lymphoma, B-Cell / Q000150:complications / Q000188:drug therapy*; D008727:Methotrexate / Q000627:therapeutic use; D013577:Syndrome
D018501:Antirheumatic Agents; D000998:Antiviral Agents; D000212:Acyclovir; D008727:Methotrexate