Development tuberculous meningitis during chemotherapy for CD5-positive diffuse large B-cell lymphoma.
The patient was a 62-year-old woman with CD5(+) diffuse large B-cell lymphoma. Treatment with the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) was started. On the eleventh day of the third cycle, headache and low grade fever developed. Her consciousness gradually deteriorated. Seven days after symptom onset, she was brought to the emergency department of our hospital. Cerebrospinal fluid (CSF) analysis revealed a white blood cell count of 25/μl, and a protein level of 188 mg/dl. Antibacterial and antiviral agents were administered based on a diagnosis of acute meningitis. She showed no improvement. We performed another lumbar puncture and intrathecal chemotherapy, a combination of methotrexate and dexamethasone, was administered because we suspected central nervous system involvement of lymphoma. She showed transient improvement. On day 12, we started the R-MPV regimen (rituximab, methotrexate, procarbazine, and vincristine). However, fever and disturbance of consciousness persisted. On day 20, we empirically started anti-tuberculosis treatment. Four days later, tubercle bacilli were confirmed by CSF culture after a 23-day incubation. We ultimately confirmed a diagnosis of tuberculous meningitis. Impaired cellular immunity in lymphoma patients increases the risk of tuberculosis. It is important to consider tuberculous meningitis in the differential diagnosis of a lymphoma patient presenting with meningitis.
Division of Hematology, Saitama Medical Center, Jichi Medical University.
Yuki
Y
Teramura
Kazuaki
K
Kameda
Junya
J
Kanda
Ayumi
A
Gomyo
Jin
J
Hayakawa
Yu
Y
Akahoshi
Yusuke
Y
Komiya
Naonori
N
Harada
Tomotaka
T
Ugai
Yuko
Y
Ishihara
Koji
K
Kawamura
Kana
K
Sakamoto
Miki
M
Sato
Hidenori
H
Wada
Kiriko
K
Terasako-Saito
Shun-Ichi
S
Kimura
Misato
M
Kikuchi
Hideki
H
Nakasone
Shinichi
S
Kako
Yoshinobu
Y
Kanda
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018956:CD5 Antigens / Q000032:analysis / Q000276:immunology; D003520:Cyclophosphamide / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000737:chemistry / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000188:drug therapy; D014750:Vincristine / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D058846:Antibodies, Monoclonal, Murine-Derived; D018956:CD5 Antigens; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone; D008727:Methotrexate