DIFFUSE'LARGE'BICELL'LYMPHOMA'ASSOCIATED'WITH'RHUPUS'SYNDROME.'
POSTER'48'
CASE'REPORT'AND'LITERATURE'REVIEW'
'
Karen! ValdesJDiaz,! Halbert! HernandezJNegrin,! Madyaret! AguilaJCarbelo,! Leonel! ValdesJLeiva! and!
Dianelys!PedrazaJGonzalez,!Arnaldo!Milian!
!
Hospital,!Santa!Clara,!Cuba!
!
Background:! The! development! of! lymphoproliferative! disorders! including! nonJHodgkin!
lymphomas!in!patients!with!systemic!autoimmune!disease!(SAD)!can!be!twice!as!high!as!in!
the! general! population.! The! use! of! drugs! such! as! methotrexate! has! been! proposed! as! a!
trigger! for! the! mechanism! of! carcinogenesis,! although! this! continues! to! be! a! controversial!
issue! in! the! international! scientific! community,! invoking! the! activity! and! persistent!
inflammatory!effect!of!the!disease!as!the!major!predisposing!agents!for!lymphogenesis.!The!
overlap!of!EAS!is!considered!a!rare!phenomenon,!receiving!the!name!of!Rhupus!syndrome!
(ShR),! when! it! comes! to! the! association! of! rheumatoid! arthritis! (RA)! and! systemic! lupus!
erythemetosus! (SLE).! The! infrequent! incidence! of! this! syndrome! means! that! the! existing!
scientific! evidence! relies! on! isolated! case! reports,! not! finding! a! previous! report! of! an!
association! between! RhS! and! secondary! nonJHodgkin! lymphoma.! Case! summary:! 56JyearJ
old!white!female!patient,!6JyearJold!diagnosis!of!SLE.!2!years!ago!she!started!with!episodes!
of! symmetric! polyarthritis.! An! XJray! of! both! hands! revealed! bone! erosive! disorders.!
Immunological! studies:! positivity! of! antibodies! such! as:! antiJdoubleJchain! DNA,! antiJSmith!
and! antiJcyclic! citrullinated! peptide! antibodies,! with! which! the! diagnosis! of! ShR! was! made!
and! treatment! with! methotrexate! and! prednisone! was! started.! Three! months! prior! to!
admission,!she!began!with!significant!weight!loss,!evening!fever,!and!profuse!night!sweats!
that!led!to!a!marked!deterioration!in!her!general!condition.!He!went!to!the!emergency!room!
with!upper!digestive!bleeding!and!in!the!upper!endoscopy!a!biopsy!of!a!bleeding!ulcerated!
lesion!was!taken!at!the!gastric!fundus!level,!which!reported:!diffuse!large!B!cell!nonJHodgkin!
lymphoma.!Treatment!was!started!with!the!RJCHOP!scheme!(Rituximab,!Cyclophosphamide,!
Vincristine,! Prednisone)! and! 15! days! after! treatment! she! presented! with! severe!
pancytopenia!and!neurological!symptoms!(dysarthria,!anisocoria!and!right!hemiparesis).!In!
MRI,! images! that! correspond! to! vasculitis! of! the! central! nervous! system,! typical! of! a! basic!
autoimmune!disease,!are!observed.!During!hospital!stay,!he!developed!as!a!complication!a!
disseminated! intravascular! coagulation,! without! response! to! the! therapeutic! measures!
taken,!and!he!died!in!the!course!of!intraparenchymal!cerebral!hemorrhage.!Conclusions:!The!
timely!diagnosis!of!lymphoma!when!there!is!a!history!of!SAD!becomes!complex,!largely!due!
to!the!clinical!manifestations!common!to!both!processes,!so!any!effort!that!contributes!to!
raising!the!timely!diagnostic!suspicion!is!of!great!value!for!the!scientific!community!and!for!
the!physicians!and!care!staff!of!these!patients.!
! !
SCIENTIFIC PROGRAMME
SESSION I
HODGKIN’S DISEASE
DEBATE I
IS THERE STILL A ROLE
FOR COMBINED MODALITY
THERAPY FOR EARLY
STAGE CHL?
SESSION II
T-CELL LYMPHOMA
ROUNDTABLE I
FUTURE DIRECTIONS IN
T-CELL LYMPHOMA
SESSION III
FOLLICULAR LYMPHOMA
DEBATE II
CAN WE AVOID
CHEMOTHERAPY IN
THE MANAGEMENT OF
FOLLICULAR LYMPHOMA?
SESSION IV
RARE LYMPHOMAS –
MARGINAL ZONE
LYMPHOMA AND
WALDENSTRÖM M
ACROGLOBULINEMIA
ROUNDTABLE II – WHERE
TO GO IN RARE B-CELL
LYMPHOMAS
SESSION V
MANTLE CELL LYMPHOMA
SESSION VI
DIFFUSE LARGE B-CELL
LYMPHOMA
DEBATE III
DO WE STILL NEED ASCT
IN MCL?
SESSION VII
NOVEL THER APEUTIC
CONCEPTS IN B-CELL
LYMPHOMAS
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES