Renal infarction due to polyarteritis nodosa in a patient with angioimmunoblastic T-cell lymphoma: a case report and a brief review of the literature

Abstract

Angioimmunoblastic T-cell lymphoma is one of the most common subtypes of peripheral T-cell lymphoma (15-20% of all cases), accounting for approximately 1-2% of all non-Hodgkin lymphomas. It often presents autoimmune phenomena including hemolytic anemia, thrombocytopenia, glomerulonephrities and circulating immune complexes. Polyarteritis nodosa is an autoimmune disease characterized by necrotizing vasculitis of medium vessels, which rarely develops in association with hematological malignant disorders. Herein we report the case of a 40-year-old man who underwent lymph node biopsy in the suspicious of sarcoidosis. On the basis of histological and immunohistochemical findings, the diagnosis of angioimmunoblastic T-cell lymphoma was performed. The patient was successfully treated with cytarabine-based regimen for 6 cycles. Three months after the initial diagnosis of angioimmunoblastic T-cell lymphoma, a whole body computed tomography showed a lesion in the lower pole of the left kidney. Renal cell carcinoma was suspected, thus a nephrectomy was carried out. The histological findings were compatible with polyarteritis nodosa. To the best of our knowledge, the association between polyarteritis nodosa and angioimmunoblastic T-cell lymphoma has been described only once. This relation may be secondary to the induction of an autoimmune phenomenon by the lymphoma with the formation of circulating immune complexes, leading to vessels walls injury. A careful evaluation is needed in the management of angioimmunoblastic T-cell lymphoma patients with signs of renal failure in order to avoid delay of treatment and organ damage.

A case of enteropathy-associated T-cell lymphoma (Type I) arising in stomach without refractory celiac disease

“…It worth noting that the severe necrosis and inflammatory background, which were also observed in other extranodal T-lymphomas [5,6,11], may obscure the relatively small number of tumor cells. For the same reason, the patient in this study underwent biopsy twice under gastroscope, while the result was not satisfied because of too much necrosis.…”

Widespread lytic lesions—A metastatic or vasculitic process?

“…Vast amount of literature is available on PAN. Ambrosio et al highlight a case report that demonstrates an atypical manifestation of PAN presenting as a renal mass in a patient with angioimmunoblastic T-cell lymphoma (AITL) (sub-type of peripheral T cell lymphoma) [8] . However, the complexities of this case were different from our case as it postulated a relationship of an autoimmune process by the lymphoma leading to vessel wall injury and thus PAN.…”

Polyarteritis nodosa involving the hard palate: a case report

“…PAN is a vasculitis that affects small and medium vessels and is characterized by periods of exacerbation and remission periods [7]. This case of PAN showed the involvement of the greater palatine artery, which caused the necrosis of the area of interest.…”

“…PAN may affect multiple organs, including skin, kidneys, and gastrointestinal tract, as well as the peripheral and central nervous systems [6]. The inflammatory process causes necrosis of cells and structural components of the artery with aneurysms or stenosis formations [7]. PAN often can culminate in necrosis or hemorrhage of the affected organ.…”

“…PAN often can culminate in necrosis or hemorrhage of the affected organ. Arterial bifurcations are predilected by PAN [7]. This causes a characteristic pattern of aneurysms that Kussmaul and Maier, in their article from 1866, described as being like the apples on the branches of a tree or a wreath of roses [8].…”