A 75-year-old female with a history of stomach cancer and depression was referred to our hospital for left cervical lymphadenopathy. The biopsy of her left cervical lymph node revealed noncaseating granulomas with multinucleated giant cells. The positron emission tomography/computed tomography (PET/CT) indicated general lymphadenopathy (left supraclavicular left axillary, hepatic lymph nodes), except for the hilar lymph node. Both histology by transbronchial lung biopsy (TBLB) and analysis of broncho alveolar lavage fluid (BALF) were indicative of sarcoidosis. C-reactive protein (CRP) and soluble interleukin-2 receptor (sIL-2R) were increased in the sera. An alternative cause of granulomatous disease was ruled out, and on follow-up, she was diagnosed with sarcoidosis. Two years later, she was hospitalized for fever, anorexia, lymph node tenderness, and erythema nodosum with significant increases in CRP and sIL-2R. After admission, the repetitive axillary lymph biopsy showed the same histological findings as before, but the G-band staining showed clonal abnormalities. Bone marrow biopsy revealed abnormal lymphocytes with petal-like nuclei. Finally, she was diagnosed with malignant lymphoma infiltrating the bone marrow. After CHOP-based chemotherapy, her laboratory data, lymphadenopathy, and clinical findings improved, and she was discharged from the hospital on the 90th day. Careful medical treatment, including genetic analysis of the lymph node, is necessary in patients with sarcoidosis if lymphadenopathy is predominant.

永沼 しおり 1) 山本 多恵 1) 突田 真紀子 2) 今田 悠介 1) 古川 暁子 1) 渋谷 里絵 3) 斎藤 陽 2) 山本 譲司 2) 奥田 光崇 2) 要 旨 慢性骨髄単球性白血病(chronic myelomonocytic leukaemia：CMML)は経過中にさまざまな機序で腎障害 を来たす 1， 2) ．単球の性質上，臓器への浸潤例も少なくはないが 3， 4) ，腫瘍細胞が腎臓へ直接浸潤したことによる 腎障害は極めて稀である 5～7) ．今回，CMMLの 60 歳台女性が経過中に急性腎不全を呈し，腎生検にて腫瘍細胞の 直接浸潤を病理学的に証明できたため報告する． 〔日内会誌 111：817～822，2022〕 ポイント ・ CMMLの経過中に急性腎障害を来たした場合， 腫瘍の腎臓への直接浸潤も鑑別にあげられる． Key words 慢性骨髄単球性白血病(CMML) ，急性腎障害，急性尿細管間質性腎炎，腫瘍細胞浸潤， 腎腫大 〔第 222 回東北地方会(2021/02/20)推薦〕 〔受稿 2021/08/23，採用 2021/11/03〕 1)仙台市立病院腎臓内科， 2) 同 血液内科， 3) 同 病理診断科 Case Report；Acute tubulointerstitial nephritis due to malignant cells infiltration in a patient with chronic myelomonocytic leukaemia. Shiori Naganuma 1) ，Tae Yamamoto 1) ，Makiko Tsukita 2) ，Yusuke Konta 1) ，Akiko Furukawa 1) ，Rie Shibuya 3) ，Yo Saito 2) ，Joji Yamamoto 2) and Mitsutaka Okuda 2) ：