Diffuse large B-cell lymphoma with rapid kidney enlargement after induction of hemodialysis in a patient with IgG4-related disease.

IF 1 Q4 UROLOGY & NEPHROLOGY CEN Case Reports Pub Date : 2024-12-14 DOI:10.1007/s13730-024-00957-0

Shintaro Hara, Daisuke Morita, Ryoko Shibata, Yuki Yasui, Yoshiki Naito, Noriyoshi Fukushima, Seiya Kato, Noriko Uesugi, Yasuhiro Abe, Kosuke Masutani

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Abstract

A 76-year-old Japanese man was incidentally diagnosed with a pancreatic head tumor on computed tomography after surgery for colon cancer. He underwent pancreatoduodenectomy and was diagnosed with IgG4-related autoimmune pancreatitis. Concurrent chronic kidney disease gradually progressed and chronic hemodialysis was introduced 2 years later. Six months after the introduction of hemodialysis, follow-up abdominal computed tomography revealed marked enlargement of bilateral kidneys compared with previous images. Blood tests revealed persistent high IgG and IgG4 levels, and IgG4-related kidney disease was suspected. Thus, percutaneous kidney biopsy was performed. No evidence of IgG4-related kidney disease was detected, and a diagnosis of diffuse large B-cell lymphoma was made. Six courses of combination chemotherapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone was effective, and the patient achieved and maintained complete remission for five years. This case highlights the need to consider the possible development of malignant lymphoma within several years after IgG4-related disease, especially in cases of autoimmune pancreatitis.

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一名患有 IgG4 相关疾病的患者在接受血液透析诱导后，出现伴有肾脏快速肿大的弥漫大 B 细胞淋巴瘤。

一名76岁的日本男子在结肠癌手术后，在计算机断层扫描上被偶然诊断出患有胰腺头部肿瘤。他接受了胰十二指肠切除术并被诊断为igg4相关的自身免疫性胰腺炎。并发慢性肾脏疾病逐渐进展，2年后开始慢性血液透析。引入血液透析6个月后，随访腹部计算机断层扫描显示双侧肾脏与先前图像相比明显增大。血液检查显示IgG和IgG4水平持续高，怀疑有IgG4相关肾脏疾病。因此，我们进行了经皮肾活检。未发现igg4相关肾脏疾病的证据，诊断为弥漫性大b细胞淋巴瘤。利妥昔单抗、环磷酰胺、阿霉素、长春新碱、强的松联合化疗6个疗程有效，患者达到并维持了5年的完全缓解。本病例强调需要考虑igg4相关疾病后几年内可能发展为恶性淋巴瘤，特别是自身免疫性胰腺炎病例。

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来源期刊

CEN Case Reports UROLOGY & NEPHROLOGY-

CiteScore

1.90

自引率

0.00%

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期刊介绍： Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN). The journal publishes original case reports in nephrology and related areas. The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.