Sasaki Yosuke, Isegawa Takuya, Shimabukuro Akira, Yonaha Tomoki, Yonaha Hiroyasu
Department of Internal Medicine, Okinawa Yaeyama Hospital, Okinawa, Japan.
Department of Yonaha Medical Clinic, Okinawa, Japan.
Case Rep Nephrol Urol. 2014 May 21;4(2):95-102. doi: 10.1159/000363223. eCollection 2014 May.
Pleural effusion is a ubiquitous complication in hemodialysis (HD) patients. Common etiologies of pleural effusion in this patient group are heart failure, volume overload, parapneumonic effusion, tuberculotic pleuritis, and uremic pleuritis. Although thoracentesis is a useful diagnostic method of pleural effusion, empirical reduction of the dry weight is often attempted without thoracentesis because pleural effusion is commonly caused by volume overload and responds to the dry-weight reduction. However, this empiricism has a risk of overlooking or delaying the diagnosis of potentially fatal etiologies that need specific treatments. We report an 86-year-old human immunodeficiency virus (HIV)-negative male on HD with primary effusion lymphoma (PEL), a large-cell non-Hodgkin lymphoma presenting with characteristic lymphomatous effusions in the absence of solid tumor masses, which is in association with human herpes virus 8 (HHV8) infection in immunocompromised individuals. The patient presented with left-sided pleural effusion. This is the first case report of PEL developing in a patient receiving HD. Thoracentesis and cytological analysis of the effusion was key to the diagnosis. We also review the literature regarding pleural effusion in HD patients. Further, we examine Kaposi's sarcoma herpes virus/HHV8-negative effusion-based lymphoma, a newly proposed distinct lymphoma that clinically and cytomorphologically resembles PEL, because it can be cured without chemotherapy. This report may arouse clinicians' attention regarding the importance of evaluation for pleural effusion in HD patients, especially when the effusion or symptoms associated with pleural effusion are refractory to volume control.
胸腔积液是血液透析（HD）患者中普遍存在的并发症。该患者群体胸腔积液的常见病因包括心力衰竭、容量超负荷、类肺炎性胸腔积液、结核性胸膜炎和尿毒症性胸膜炎。虽然胸腔穿刺术是诊断胸腔积液的一种有用方法，但由于胸腔积液通常由容量超负荷引起且对减少干体重有反应，所以常常在未进行胸腔穿刺术的情况下尝试经验性地减少干体重。然而，这种经验主义存在忽视或延迟诊断需要特定治疗的潜在致命病因的风险。我们报告了一名86岁的男性血液透析患者，他未感染人类免疫缺陷病毒（HIV），患有原发性渗出性淋巴瘤（PEL），这是一种大细胞非霍奇金淋巴瘤，在没有实体肿瘤肿块的情况下表现为特征性的淋巴瘤性渗出液，与免疫功能低下个体中的人类疱疹病毒8（HHV8）感染有关。该患者表现为左侧胸腔积液。这是首例关于接受血液透析患者发生PEL的病例报告。胸腔穿刺术和对渗出液进行细胞学分析是诊断的关键。我们还回顾了有关血液透析患者胸腔积液的文献。此外，我们研究了卡波西肉瘤疱疹病毒/ HHV8阴性的基于渗出液的淋巴瘤，这是一种新提出的独特淋巴瘤，在临床和细胞形态学上类似于PEL，因为它无需化疗即可治愈。本报告可能会引起临床医生对血液透析患者胸腔积液评估重要性的关注，特别是当渗出液或与胸腔积液相关的症状对容量控制无效时。
