INTRODUCTION: Angioimmunoblastic T-cell Lymphoma (AITL) is a rare peripheral T-cell lymphoma. This is the first reported case of AITL presenting with a gastric mass. There is an association with Epstein-Barr Virus (EBV), though its role in pathogenesis is unclear. CASE DESCRIPTION/METHODS: A 64-year-old female presented for abdominal pain with a suspicious gastric mass and lymphadenopathy. She developed autoimmune hemolytic anemia during the hospital course with Coombs testing revealing mixed warm and cold agglutinins. Anti-smooth muscle antibody was positive along with serology consistent with an acute EBV infection. Gastric mass biopsy returned inconclusive. Steroids were indicated but held given suspicion for lymphoma and need for accurate tissue samples. A blood transfusion was given and resulted in an appreciable increase in bilirubin level. Following lymph node resection, methylprednisolone was given and the patient’s hemoglobin stabilized. A tissue diagnosis of AITL was made and chemotherapy led to subsequent improvement in her anemia. DISCUSSION: Since AITL was first described in the 1970s, there has been a clear association with auto-immune phenomenon and correlation with EBV. This is the fourth reported case presenting with an acute EBV infection and the first presenting as a gastric mass. 1,2 The presence of active EBV infection could potentially steer away from more insidious processes. 1 Unfortunately, AITL is aggressive and has a bleak prognosis. Despite advancing treatments, median survival is only 3 years. 3,4 The presence of active EBV infection can lead to misdiagnosis as there is some overlap in symptoms and presentation. High suspicion must be maintained for malignancy with this constellation of unusual hematological abnormalities.
Background/study aims Angioimmunoblastic T-cell Lymphoma (AITL) is a rare T-cell lymphoma often presenting with constitutional symptoms and lymphadenopathy. It can have an association with Epstein-Barr Virus (EBV) infection and auto-immune phenomena such as haemolytic anaemia. This case details a Gastric Mass as the initial findings of AITL, a rare occurrence. Patients and methods Case report detailing a 64-year-old female presenting with a suspicious gastric mass and auto-immune haemolytic anaemia. Hospital workup was notable for serology consistent with acute EBV infection and positive anti-smooth muscle antibody. Tissue biopsy and lymph node resection yielded histologic diagnosis of AITL. Results Once the patient was diagnosed with AITL, they were placed on Gemcitabine, Cisplatin, Prednisone and Thalidomide with subsequent improvement in haemolytic anaemia and gastric mass size. Conclusions This case demonstrates a unique presentation of Angioimmunoblastic T-cell Lymphoma in the context of a Gastric Mass and associated Auto-immune Haemolytic Anaemia. This case also continues to show evidence of a strong relationship between Epstein-Barr Virus and Angioimmunoblastic T-cell Lymphoma.
Immune-related cutaneous events can develop after immunotherapy. To our knowledge, we present the first reported case of isolated focal penile inflammatory ulceration in a patient being treated with Nivolumab for stage IV non-small cell lung carcinoma. He presented with a painless penile ulceration two months after initiating therapy. He had near-complete resolution of his ulcer after two weeks of topical treatment. Histologic evaluation revealed a drug eruption. While cutaneous events are a well-known side effect of immunotherapy, this is the first report of an isolated penile lesion from such therapy.
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