Pulmonary Manifestations of Systemic Disease |

Multiple Pulmonary Nodules in a Patient Treated Successfully for Non-Hodgkin’s Lymphoma FREE TO VIEW

Kristyn Sayball, DO; Salwa Elshowaia, MD; Frederick Glauser, MD
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Virginia Commonwealth University Medical Center, Richmond, VA

Chest. 2015;148(4_MeetingAbstracts):858A. doi:10.1378/chest.2264840
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SESSION TITLE: Pulmonary Manifestations of Systemic Disease Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: The development of abnormalities on chest imaging after treatment for lymphoma offers a wide differential diagnoses, the most ominous of which is recurrent malignancy. However, in the asymptomatic patient presenting with multiple pulmonary nodules, more unusual diagnoses must be considered.

CASE PRESENTATION: The patient is a 72 year old man who completed chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone for diffuse large B cell lymphoma in December of 2013, at which point he was declared in remission. As part of his follow-up care, he underwent surveillance CT imaging, which remained unremarkable until September 2014, when he developed multiple scattered bilateral pulmonary and parenchymal based nodules of varying sizes. He was then referred to pulmonary clinic. On interview, he stated that he felt well, denying dyspnea, cough, fevers, night sweats, or weight loss. Physical exam revealed normal vital signs and a well appearing gentleman without any palpable lymphadenopathy. He was referred for CT guided biopsy of one of the nodules; the pathology showed non-caseating granulomatous inflammation. Cytogenetic studie did not reveal any changes concerning for recurrent lymphoma and stains for acid-fast bacilli and fungal elements were negative. Based on his history, imaging, and pathology results the diagnosis of post-lymphoma sarcoidosis was made. As he was asymptomatic, no sarcoid specific therapy was initiated. He has since undergone serial chest CT imaging, which has shown near resolution of the pulmonary nodules. His lymphoma remains in remission.

DISCUSSION: The diagnosis of sarcoidosis preceding lymphoma is uncommon and has been reported as the sarcoidosis-lymphoma syndrome. The development of sarcoidosis after treatment for lymphoma is much more unusual and has been hypothesized to represent an overly robust immune response to malignant cells and may actually portend a positive prognosis. As with our patient, the majority of patients with this disorder achieved long term cancer remission while not suffering any ill-effects from the sarcoid, often despite no sarcoid specific treatment.

CONCLUSIONS: The diagnosis of sarcoidosis following treatment for lymphoma is important to keep in the differential diagnosis when evaluating a patient with abnormal imaging or new symptoms, and a tissue diagnosis should always be obtained prior to making any treatment decisions.

Reference #1: London, J et al. Sarcoidosis Occurring After Lymphoma. Medicine 2014,Vol.93(21),p.e121-e121

DISCLOSURE: The following authors have nothing to disclose: Kristyn Sayball, Salwa Elshowaia, Frederick Glauser

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