Anti-interferon-γ Antibody-seropositive Disseminated Nontuberculous Mycobacterial Infection Mimicking POEMS and TAFRO Syndromes

Hidekawa, Chiharu; Yoshimi, Ryusuke; Kishimoto, Daiga; Kato, Hideaki; Mitsuhashi, Masaki; Sakurai, Natsuki; Sato, Yuichiro; Uehara, Takeaki; Iizuka, Yasuhiro; Komiya, Takaaki; Hamada, Naoki; Nagai, Hideto; Soejima, Yutaro; Kamiyama, Reikou; Takase‐Minegishi, Kaoru; Kirino, Yohei; Sakagami, Takuro; Nakajima, Hitoshi

doi:10.2169/internalmedicine.8366-21

Cited by 2 publications

(1 citation statement)

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“…These symptoms seemed to be the result of a cytokine storm induced by sepsis but were difficult to distinguish from other causes, such as TAFRO syndrome. There have been several case reports of patients with TAFRO syndrome successfully treated with glucocorticoid treatment or in combination with other immunosuppressants, such as rituximab and tocilizumab [ 14 – 18 ]. The usefulness of tocilizumab is based on the observation of elevated serum interleukin (IL)-6 levels in patients with TAFRO syndrome.…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia, anasarca, and renal insufficiency as severe and rare complications of Hodgkin lymphoma: a case report

et al. 2023

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Background Patients with Hodgkin lymphoma exhibit various clinical presentations. Needle biopsy of the lymph nodes is a minimally invasive procedure and a useful diagnostic method for malignant lymphomas. However, at times it is difficult to differentiate malignant lymphomas from reactive lymph node changes using a small amount of biopsy material. Case presentation A 77-year-old Japanese man was referred to the emergency department of our hospital owing to high fever and disturbance of consciousness. We diagnosed sepsis due to an acute biliary tract infection because he presented with Charcot’s triad—fever, jaundice, and right-sided abdominal pain. However, he did not respond well to antimicrobial therapy and his high fever persisted. Considering the swelling of the right cervical, mediastinal, and intraperitoneal lymph nodes and splenomegaly detected on computed tomography, a differential diagnosis of malignant lymphoma was needed. Hence, we performed a needle biopsy of the right cervical lymph node; however, the amount of sample obtained was insufficient in establishing a definitive diagnosis of malignant lymphoma. Furthermore, during hospitalization, the patient developed thrombocytopenia, anasarca, and renal insufficiency. These symptoms seemed to be the typical signs of the thrombocytopenia, anasarca, fever, reticulin fibrosis or renal insufficiency, and organomegaly syndrome. Next, an external incisional mass biopsy of the right cervical lymph node was performed, which helped identify Hodgkin and Reed–Sternberg cells. Collectively, we established a definitive diagnosis of Hodgkin lymphoma with lymphoma-associated hemophagocytic syndrome. Conclusions This case highlights the importance of performing an external incisional mass biopsy of the lymph nodes for the early diagnosis and treatment, if malignant lymphoma is strongly suspected.

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Section: Discussionmentioning

confidence: 99%