Diffuse Large B-Cell Lymphoma (DLBCL)
Patient presentation
A 42 year-old female (K.G.) presents to emergency department with
influenza-like symptoms, swollen, non-painful lymph nodes in neck, armpits,
and groin. Pt complains of fatigue, a “nagging cough,” and back and
abdominal pain with occasional diarrhea (sometimes with blood in it). Pt
has also been having persistent night sweats, fevers and loss of weight
greater than 10%. Pt has a history of colorectal cancer (treated and in
remission), diabetes, and a significant alcohol/drug abuse history.
Differential list
Differential diagnoses include: infection (viral, bacterial, parasitic),
lymphangioma, drug toxicity, Hodgkin’s vs. non-Hodgkin’s lymphoma.
Diagnosis
Lab tests: CBC with diff, peripheral blood smear (assessing for
cytopenia and lymphoma cells), CMP, LFT (elevated), LDH (=634, elevated),
immunoglobulin levels (elevated), Hepatitis panel, HIV (reactive).
Diagnostic procedures: CT scan, PET scan; Lymph node biopsy; Bone
marrow to assess involvement; LP/MRI of brain if possibility of CNS
involvement.
Diagnosis: Advanced Diffused Large B-Cell Lymphoma (Stage IV,
disease on both sides of the body and above and below the diaphragm, also
GI/liver lymph node involvement) and HIV (common to have lymphoma secondary
to progressed HIV diagnosis).
Treatment:
Begin chemotherapy: R-CHOP. Radiation Therapy is also an option for
treatment. Pt was also started on HAART treatment for HIV due to her low CD4
count. Pt’s inguinal biopsy became severely infected leading to sepsis and
K.G. spent several weeks in the ICU.
Outcome/Prognosis:
K.G. has a poor prognosis given her history of colorectal cancer, her newly
diagnosed HIV and her staging. K.G. had several week to month long visits
between the Hematology/Oncology unit and the ICU; upon last admission, her
infection had cleared, she was in remission from the DLBCL and she was
compliant with her HAART medications.