Malt Lymphoma Leading to Interstitial Lung Disease

Abstract

Interstitial lung diseases (ILD ) are a group of diseases classified together due to similar clinical, radiographic, and pathological presentation. ILD is associated with systemic diseases, environmental exposures, infections, collagen tissue diseases, sarcoidosis, vasculitis, and idiopathic causes. Mucosa-associated lymphoid tissue (MALT) is cancer that arises from postgerminal center memory B cells with the capacity to differentiate into marginal zone cells and plasma cells. MALT lymphoma is commonly found in the stomach, salivary glands, small bowel, lung, and thyroid. CASE PRESENTATION:A 39-year-old male with a medical history of Noonan syndrome, ulcerative colitis, and MALT lymphoma presented complaining of cough and difficulty breathing. Prior admission PET-scan showed a new right axillary lymph node, multiple nodularities, and ground-glass opacities throughout the lungs, some with metabolic activity. Initial vital signs indicated tachypnea, tachycardia, and hypoxia. Physical exam was notable for crackles throughout the lungs. Initial labs were remarkable for leukocytosis of 14,700 cells/m3 and C-reactive protein of 13.3 mg/dl. Chest CT angiogram showed patchy ground-glass opacities and alveolar and interstitial infiltrate bilaterally predominantly peripherally consistent with pneumonia superimposed on interstitial lung changes. The patient was started on a Nasal cannula and on intravenous antibiotics. Due to worsening of his symptoms, bronchoscopy was performed and showed purulent secretion on trachea and airways with erythematous, friable, and swollen bronchial mucosa. Antibiotics were escalated for broad coverage and steroids were added post-bronchoscopy. Lung wash was positive for squamous cells and candida yeast. The patient's condition improved and he was discharged with steroids.DISCUSSION: ILD are characterized by diffuse inflammation, fibrosis, and structural damage of the alveolar and airway architecture. Diagnosis tools included pulmonary function tests, bronchoalveolar lavage, HRCT, tests for infections, and autoimmune disorders. Lung biopsy is indicated in patients not responding to nonspecific management. In our patient infiltration of his malignancy to his lung led to interstitial lung changes. Alteration of the lung structure is due to the formation of intraparenchymal masses composed of centrocyte-like cells, plasmacytoid lymphocytes, and plasma cells forming lymphoepithelial lesions and exhibiting lymphangitic growth pattern. Treatment for this patient focused on treating his underlying malignancy. Treatment options included single therapy rituximab or combination therapy with RþCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) or RþBendamustin. CONCLUSIONS:In conclusion when diagnosing ILD lymphoma must be included in the differential diagnosis along with sarcoidosis, asbestosis, autoimmune disorders, chemicals, and drugs.