title: Lymphoma in a patient with systemic lupus erythematosus.
abstract: BACKGROUND
  A 40-year-old woman with a 10-year history of systemic lupus erythematosus (SLE) presented with fever, lymphadenopathy and fatigue. Before that time, her SLE symptoms had been controlled with hydroxychloroquine, NSAIDs, and an occasional short course of moderate-dose prednisone. Two months before presentation, she experienced fevers ranging from 38.3 to 39.7 degrees C, but she had no specific symptoms that suggested local infection.
  
  
  METHODS
  Physical examination, multiple blood cultures, and laboratory investigations that included the following tests: hemoglobin concentration; erythrocyte sedimentation rate; C-reactive protein level; serum lactate dehydrogenase level; aspartate aminotransferase level; alanine aminotransferase level; serum complement C3 and C4 levels; white-blood-cell count; platelet count; urinalysis; serum creatinine level; CT of the chest and abdomen; bone-marrow biopsy; serum electrophoresis; and tests for Epstein-Barr virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, HIV-1, antinuclear antibodies, antibodies to Smith antigen, antibodies to double-stranded DNA, and antibodies to Ro and La.
  
  
  METHODS
  Stage IVB diffuse large B-cell lymphoma with marrow and liver involvement concurrent with SLE.
  
  
  RESULTS
  The patient promptly underwent chemotherapy, receiving three courses of 3 mg/m(2) vindesine on day 1, 1,500 mg/m(2) cyclophosphamide and 80 mg/m(2) doxorubicin on day 2, and 50 mg/m(2) prednisolone on days 1-5.
authors.affiliation: Canadian Institutes for Health Research (CIHR) and Fonds de la recherche en santé du Québec (FRSQ) Investigator, Montreal, Québec, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.forename: Rosalind
authors.initials: R
authors.lastname: Ramsey-Goldman
authors.forename: Silvy
authors.initials: S
authors.lastname: Lachance
authors.forename: Christian A
authors.initials: CA
authors.lastname: Pineau
authors.forename: Ann E
authors.initials: AE
authors.lastname: Clarke
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001855:Bone Marrow Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage; D014751:Vindesine / Q000008:administration & dosage
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D014751:Vindesine