A unique case of extranodal marginal zone lymphoma with synchronous pulmonary and dermatologic manifestations
An 89-year-old male with a medical history of non-ischemic cardiomyopathy was initially admitted with acute hypoxic respiratory failure attributed to heart failure exacerbation. Aside from progressive dyspnea, a non-pruritic, non-painful rash and constitutional symptoms were reported. Initial work-u...
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Elsevier
2025-01-01
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| Series: | Respiratory Medicine Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S221300712400176X |
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| author | Carlo Arevalo Fernando Camacho Joseph Modrak |
| author_facet | Carlo Arevalo Fernando Camacho Joseph Modrak |
| author_sort | Carlo Arevalo |
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| description | An 89-year-old male with a medical history of non-ischemic cardiomyopathy was initially admitted with acute hypoxic respiratory failure attributed to heart failure exacerbation. Aside from progressive dyspnea, a non-pruritic, non-painful rash and constitutional symptoms were reported. Initial work-up was remarkable for normocytic anemia, lymphopenia, mild hypercalcemia, and elevated inflammatory markers. Despite aggressive diuresis, his respiratory distress worsened requiring up-titration of supplemental oxygen (6–8L/min). Subsequent chest CT showed diffuse, ill-defined areas of consolidation and ground-glass opacities (GGOs) with areas of solid and ground-glass nodularity. Rheumatologic work-up was remarkable for mildly elevated ANA titer of 1:60, and positive anti-centromere antibody of 1.8 AI (normal range 0–0.9 AI). Infectious work-up was negative. Due to high oxygen requirements, tissue sampling was obtained by skin biopsy instead of bronchoscopy. After biopsy testing, prednisone 60 mg was started with posterior clinical and radiographic improvement. Biopsy results revealed cutaneous MZL. Follow-up PET scan showed persistent but improved diffuse GGOs and nodular opacities. Given the clinical presentation, imaging and skin biopsy results, the diagnosis was compatible with EMZL with synchronous pulmonary and skin manifestations. Empiric treatment with Rituximab and steroid taper was planned. At 6-month follow-up, the patient reported clinical and respiratory improvement. |
| format | Article |
| id | doaj-art-ebf29ff7529a4966a671fe88ba01a480 |
| institution | Kabale University |
| issn | 2213-0071 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Respiratory Medicine Case Reports |
| spelling | doaj-art-ebf29ff7529a4966a671fe88ba01a4802025-02-09T05:00:18ZengElsevierRespiratory Medicine Case Reports2213-00712025-01-0153102153A unique case of extranodal marginal zone lymphoma with synchronous pulmonary and dermatologic manifestationsCarlo Arevalo0Fernando Camacho1Joseph Modrak2Division of Pulmonary and Critical Care, University of Rochester, Rochester, NY, USA; Corresponding author.Division of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health Science Center, Houston, TX, USADivision of Pulmonary and Critical Care, University of Rochester, Rochester, NY, USAAn 89-year-old male with a medical history of non-ischemic cardiomyopathy was initially admitted with acute hypoxic respiratory failure attributed to heart failure exacerbation. Aside from progressive dyspnea, a non-pruritic, non-painful rash and constitutional symptoms were reported. Initial work-up was remarkable for normocytic anemia, lymphopenia, mild hypercalcemia, and elevated inflammatory markers. Despite aggressive diuresis, his respiratory distress worsened requiring up-titration of supplemental oxygen (6–8L/min). Subsequent chest CT showed diffuse, ill-defined areas of consolidation and ground-glass opacities (GGOs) with areas of solid and ground-glass nodularity. Rheumatologic work-up was remarkable for mildly elevated ANA titer of 1:60, and positive anti-centromere antibody of 1.8 AI (normal range 0–0.9 AI). Infectious work-up was negative. Due to high oxygen requirements, tissue sampling was obtained by skin biopsy instead of bronchoscopy. After biopsy testing, prednisone 60 mg was started with posterior clinical and radiographic improvement. Biopsy results revealed cutaneous MZL. Follow-up PET scan showed persistent but improved diffuse GGOs and nodular opacities. Given the clinical presentation, imaging and skin biopsy results, the diagnosis was compatible with EMZL with synchronous pulmonary and skin manifestations. Empiric treatment with Rituximab and steroid taper was planned. At 6-month follow-up, the patient reported clinical and respiratory improvement.http://www.sciencedirect.com/science/article/pii/S221300712400176X |
| spellingShingle | Carlo Arevalo Fernando Camacho Joseph Modrak A unique case of extranodal marginal zone lymphoma with synchronous pulmonary and dermatologic manifestations Respiratory Medicine Case Reports |
| title | A unique case of extranodal marginal zone lymphoma with synchronous pulmonary and dermatologic manifestations |
| title_full | A unique case of extranodal marginal zone lymphoma with synchronous pulmonary and dermatologic manifestations |
| title_fullStr | A unique case of extranodal marginal zone lymphoma with synchronous pulmonary and dermatologic manifestations |
| title_full_unstemmed | A unique case of extranodal marginal zone lymphoma with synchronous pulmonary and dermatologic manifestations |
| title_short | A unique case of extranodal marginal zone lymphoma with synchronous pulmonary and dermatologic manifestations |
| title_sort | unique case of extranodal marginal zone lymphoma with synchronous pulmonary and dermatologic manifestations |
| url | http://www.sciencedirect.com/science/article/pii/S221300712400176X |
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