Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Jung-Gu, Incheon 400-711, Republic of Korea.
Mod Rheumatol. 2013 Jul;23(4):817-22. doi: 10.1007/s10165-012-0712-z. Epub 2012 Jul 12.
Angioimmunoblastic T cell lymphoma (AITL) is a rare non-Hodgkin lymphoma that presents with profound immune dysfunction and immunodeficiency. The clinical and laboratory findings associated with AITL are similar to those of rheumatic disease, and AITL has been reported to be concurrent in patients with several rheumatic diseases. We present one case of AITL occurring in a patient with ankylosing spondylitis (AS) after treatment with etanercept. Constitutional symptoms and aggravation of peripheral arthritis in elderly AS patients may be due not only to flare-ups of AS but also to other complicating diseases, such as lymphoma. Although the occurrence of lymphoma in AS patients treated with etanercept has only rarely been reported, clinicians should keep in mind that instances of aggravation of peripheral arthritis in elderly AS patients occurring after immunosuppressant treatment may be due to other complicating systemic diseases such as AITL, rather than the rheumatic disease itself. Further study is needed in order to investigate whether or not using a TNF-α blocker such as etanercept increases the risk of lymphoma, especially for cases associated with Epstein-Barr virus.
血管免疫母细胞性 T 细胞淋巴瘤（AITL）是一种罕见的非霍奇金淋巴瘤，其表现为严重的免疫功能障碍和免疫缺陷。AITL 的临床和实验室发现与风湿性疾病相似，并且已经有报道称 AITL 与几种风湿性疾病同时存在。我们报告了一例在使用依那西普治疗后发生在强直性脊柱炎（AS）患者中的 AITL 病例。老年 AS 患者的全身症状和外周关节炎加重不仅可能是由于 AS 发作，还可能是由于其他合并疾病，如淋巴瘤。虽然在使用依那西普治疗的 AS 患者中发生淋巴瘤的情况很少见，但临床医生应牢记，免疫抑制剂治疗后老年 AS 患者外周关节炎加重的情况可能是由于其他合并的全身疾病，如 AITL，而不是风湿性疾病本身。需要进一步研究以探讨使用 TNF-α 阻滞剂（如依那西普）是否会增加淋巴瘤的风险，尤其是与 Epstein-Barr 病毒相关的情况。
