title: Primary bone marrow lymphoma presenting with cold-type autoimmune hemolytic anemia.
abstract: We report a rare case of primary bone marrow lymphoma with cold-type autoimmune hemolytic anemia (AIHA). A 70-year-old Japanese woman with suspected liver disorder presented to our hospital with palpitation. On physical examination, she had jaundice and signs of anemia. No lymphadenopathy or hepatosplenomegaly was noted. A direct antiglobulin test was positive for complement C3b and C3d. Anti-IgG testing was negative. Cold agglutinin was positive with a titer of 1:≥8,192, and haptoglobin was absent. A diagnosis of cold-type AIHA was made. Bone marrow biopsy revealed involvement with a population of lymphocytes that were positive for CD20 (L-26), CD79a, and Bcl-2. No lymphoma lesion was detected on computerized tomography or on upper and lower endoscopy. The patient was diagnosed with diffuse large B cell lymphoma (DLBCL) presenting with cold-type AIHA. She was treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone, resulting in complete remission after six cycles. As of 22 months after presentation, no signs of cold-type AIHA or lymphoma were present.
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Fukaya Hospital, 5-8-1 Kamishiba-chou-nishi, Fukaya, Saitama 366-0052 Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kosugi
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Fukaya Hospital, 5-8-1 Kamishiba-chou-nishi, Fukaya, Saitama 366-0052 Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hoshikawa
keywords: Cold-type autoimmune hemolytic anemia; Diffuse large B-cell lymphoma; Primary bone marrow lymphoma