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Case Reports
. 2011 Dec;84(4):433-8.

Diffuse large cell lymphoma presenting as a sacral mass and lupus anticoagulant

Lilangi S Ediriwickrema  1 , Wajih Zaheer
Affiliations
Case Reports

Diffuse large cell lymphoma presenting as a sacral mass and lupus anticoagulant

Lilangi S Ediriwickrema et al. Yale J Biol Med. 2011 Dec.

Abstract

A 67-year-old gentleman presented to Yale-New Haven Hospital (YNHH) for assessment of a supratherapeutic INR and sacral lesion. Hematologic workup revealed elevated ESR, PT, INR, PTT, and CRP, mixing studies that failed to correct, and a positive Russell Viper Venom Test (RVVT), which confirmed the presence of lupus anticoagulant (LA), a subtype of antiphospholipid syndrome (APA). Pathology of the patient's sacral lesion revealed diffuse large B-cell lymphoma. This case provides insight into the association between APA and lymphoid neoplasm. The patient's unique presentation is in marked contrast to other reports of APA and lymphoid malignancy, which are typically associated with elevated PTT, normal PT, minimal extranodal disease, and potential thrombotic complications. Further, treatment with Rituximab-CHOP chemotherapy led to excellent clinical response with tumor remission and normalization of PT and PTT.

Keywords: R-CHOP; antiphospholipid syndrome; coagulopathy; diffuse large cell lymphoma; lupus anticoagulant; sacral lesion; supratherapeutic INR.

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