Peripheral-T-Cell Lymphoma with Hemophagocytic Histiocytosis Localised to the Bone Marrow Associated with Inappropriate Secretion of Antidiuretic Hormone

Abstract

A patient with high fever, loss of weight and profound pancytopenia is reported. Peripheral T-cell lymphoma with hemophagocytosis was diagnosed. Bone marrow was the only localisation of the lymphoma. At presentation there were (i) a coagulopathy consistent with hemophagocytic histiocytosis (ii) the features of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). These different abnormalities disappeared after chemotherapy and reappeared during each of the 2 periods of disease progression. The patient died 6 months after diagnosis without ever achieving complete remission. As far as we are aware this is the first case report of T-cell lymphoma with hemophagocytic syndrome localised to the bone marrow and associated with SIADH.

Intravascular Large B-cell Lymphoma with Preceding Syndrome of Inappropriate Secretion of Antidiuretic Hormone

“…For instance, there is evidence that intravenous administration of IL-6 triggers secretion of ADH (13). The concurrent development of HPS and SIADH in some cases of hematological malignancies also supports the role of cytokines in the development of SIADH (14)(15)(16). In the present case, HPS was not evident; however, the elevated serum level of sIL-2R indicated acti-vation of T and B cells and a presumably hypercytokine state.…”

Hyponatremia and syndrome of inappropriate antidiuretic hormone secretion complicating stem cell transplantation

“…SIADH has also been reported to be associated with several hematological diseases such as NHL and Hodgkin's disease. [12][13][14][15] The most common cause of SIADH in NHL is thought to be either vinca alkaloid-containing chemotherapy or direct invasion into the pituitary gland. Chubati et al 12 have reported three cases of NHL in association with hemophagocytic syndrome and SIADH and have proposed an attractive alternative hypothesis.…”

Syndrome of inappropriate antidiuretic hormone secretion associated with acute myeloid leukemia with multilineage dysplasia

“…However, SIADH has been reported to occur after the initiation of chemotherapy reflecting tumor lysis and a massive release of ADH. SIADH is most frequently associated with small-cell lung cancer, but may also occur in association with a variety of other carcinomas arising in the brain, prostate, bladder, pancreas, adrenal cortex, duodenum, head, and neck, and with mesothelioma, thymoma, sarcoma, peripheral T-cell lymphoma, anaplastic large cell lymphoma, acute myelomonocytic leukemia, and Hodgkin's disease [1,[6][7][8][9][10][11][12][13][14][15]. Although the clinical data in these studies was compatible with the diagnosis of SIADH, it was not confirmed by immunohistochemical techniques.…”