Effective anti-viral therapy for hemophagocytic syndrome associated with B-cell lymphoma

Leuk Lymphoma. 2003 Oct;44(10):1807-10. doi: 10.1080/1042819031000103926.

Abstract

A rheumatoid arthritis (RA) patient treated with low-dose methotrexate (MTX) therapy suffered from hemophagocytic syndrome (HPS) associated with B-cell lymphoma (B-LAHS). Administration of acyclovir and intravenous immunoglobulin promptly resolved laboratory test abnormalities accompanied with HPS. Moreover, hemophagocytic histiocytes and lymphoma cells in the bone marrow disappeared without anti-cancer therapy. Two months after reintroduction of MTX for RA flare, lymphoma re-grew rapidly without bone marrow involvement and HPS. Two cycles of combination chemotherapy induced the lymphoma to a complete remission/unconfirmed (CRu), but then the chemotherapy was discontinued due to severe side effects. In this case, on the basis of RA and MTX induced immunosuppressive state, Epstein-Barr virus (EBV) infection was associated with the development of HPS and lymphoma. Anti-viral therapy alone was effective against HPS and lymphoma at initial presentation and improved her general condition. This case indicates that anti-cancer therapy should be preceded by anti-viral therapy and withdrawal of immunosuppressive therapy in patients under immunosuppressive therapy, as long as the clinical situation permits.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / therapeutic use*
  • Aged
  • Antirheumatic Agents / therapeutic use
  • Antiviral Agents / therapeutic use*
  • Arthritis, Rheumatoid / complications
  • Epstein-Barr Virus Infections / diagnosis
  • Epstein-Barr Virus Infections / drug therapy
  • Female
  • Herpesvirus 4, Human / isolation & purification
  • Histiocytosis, Non-Langerhans-Cell / drug therapy*
  • Histiocytosis, Non-Langerhans-Cell / etiology
  • Humans
  • Lymphoma, B-Cell / complications
  • Lymphoma, B-Cell / drug therapy*
  • Methotrexate / therapeutic use
  • Syndrome

Substances

  • Antirheumatic Agents
  • Antiviral Agents
  • Acyclovir
  • Methotrexate