Composite Lymphoma after Treatment with Infliximab for Sarcoidosis and Ankylosing Spondylitis

Abstract

Lymphoid proliferations and lymphomas associated with immune deficiency and dysregulation (LP/L-IDD) are rare entities associated with the use of immunosuppressive drugs (ISD) for autoimmune conditions. Composite lymphomas, featuring both B-cell and T-cell lymphomas, are infrequent, and their occurrence as LP/L-IDD is rare. We herein report the case of a 70-year-old man with right pleural effusion and lymphadenopathy, who was treated with infliximab for sarcoidosis and ankylosing spondylitis. A biopsy revealed a composite lymphoma of DLBCL and PTCL-NOS. CHOP chemotherapy led to significant remission. This case report emphasizes the need to consider lymphoma in patients with autoimmune diseases such as sarcoidosis and ankylosing spondylitis, especially those treated with ISDs.

Keywords: OIIA-LPD; ankylosing spondylitis; composite lymphoma; sarcoidosis.

Figure 1.

Radiological findings of the case. Chest X-ray and computed tomography (CT) revealed right pleural effusion and mediastinum lymphadenopathy (A and B). C shows enlarged lymph nodes with an increased uptake of FDG in the left cervical, mediastinum, and bilateral hilum, as well as in the right pleura on 18F-FDG PET/CT. The pleural effusion decreased, and lymphadenopathy was improved after treatment (D); however, enlargement of the mediastinal lymph nodes was observed one month later (E).

Figure 2.

Pathological findings of the left crevicular lymph node. Medium to large-sized atypical lymphocytes with prominent nuclear division were found by Hematoxylin and Eosin staining of the T cell and B cell lymphomas (magnification: A, B: 200×; C, D: 400×). Most atypical cells were positive for CD3 (E), and some atypical cells were negative for CD3 and positive for CD79a, consistent with DLBCL (F).