title: Diffuse large B-cell lymphoma with hemolytic crisis developed twenty years after the onset of Evans syndrome.
abstract: A 65-year-old woman was diagnosed with Coombs-positive autoimmune hemolytic anemia (AIHA) and pure red cell aplasia (PRCA) in May 1992. One month later, her PRCA went into remission following treatment but she developed idiopathic thrombocytopenic purpura and was diagnosed with Evans syndrome. Although her condition resolved with administration of prednisolone and azathioprine, it was necessary to continue treatment with gradual tapering over the following two decades. In October 2012, her hemolytic anemia again worsened, and lymph node swelling, splenomegaly and B symptoms developed. She was diagnosed as having diffuse large B-cell lymphoma (DLBCL) based on lymph node biopsy. However, AIHA was not considered to be the cause of her hemolytic anemia, but rather to be related to DLBCL. This was because a Coombs test and other extensive investigations for Coombs negative-AIHA yielded negative results. The patient underwent CHOP therapy, and all of her symptoms improved. Herein, we report this rare case in which DLBCL developed after the onset of Evans syndrome.
authors.affiliation: Hematology, Graduate School of Medicine, Osaka City University.
authors.forename: Takuro
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Takahiko
authors.initials: T
authors.lastname: Nakane
authors.forename: Toyomi
authors.initials: T
authors.lastname: Kamesaki
authors.forename: Akiko
authors.initials: A
authors.lastname: Inaba
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Nishimoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Mukai
authors.forename: Manami
authors.initials: M
authors.lastname: Sakabe
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ohsawa
authors.forename: Keizo
authors.initials: K
authors.lastname: Fujino
authors.forename: Hideo
authors.initials: H
authors.lastname: Koh
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Nakao
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Nakamae
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
mesh_terms: D017668:Age of Onset; D000368:Aged; D000743:Anemia, Hemolytic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D011239:Prednisolone