Spontaneous remission of Epstein-Barr virus-negative non-Hodgkin's lymphoma after withdrawal of cyclosporine in a patient with refractory anemia.
A 70-year-old man presented with pancytopenia in August 2000, and the results of a bone marrow examination performed in January 2001 confirmed the diagnosis of refractory anemia. He was treated with cyclosporine (CsA) at 3.3 mg/kg per day, and the pancytopenia improved. The patient complained of epigastralgia 21 months later, and a gastric endoscopic examination showed an ulcer with a cleaved bank. A biopsy revealed diffuse large B-cell lymphoma. In situ hybridization analysis detected no Epstein-Barr virus (EBV) in the lymphoma. CsA treatment was discontinued, and a gastrectomy was performed 31 days later. A detailed histologic examination revealed no infiltration of abnormal B-cells in the resected stomach. Although EBV-positive lymphoma is a known complication of immunosuppressive therapy, no causal association between immunosuppressants and EBV-negative lymphoma has been established. The spontaneous remission observed after the withdrawal of CsA treatment suggests that immunosuppressive therapy can be a pathogenic factor in a subset of EBV-negative lymphomas.
Second Department of Internal Medicine, Oita Medical University, Hasama-machi, Oita, Japan. mogata@oita-med.ac.jp
Masao
M
Ogata
Hiroshi
H
Kikuchi
Keiji
K
Ono
Eiichi
E
Ohtsuka
Ayako
A
Gamachi
Kenji
K
Kashima
Masaru
M
Nasu
D000368:Aged; D000753:Anemia, Refractory / Q000188:drug therapy*; D016572:Cyclosporine / Q000009:adverse effects*; D020031:Epstein-Barr Virus Infections; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008228:Lymphoma, Non-Hodgkin / Q000139:chemically induced* / Q000473:pathology / Q000821:virology; D008297:Male; D012075:Remission, Spontaneous
D007166:Immunosuppressive Agents; D016572:Cyclosporine