Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita Ishinomaki, Miyagi, 986-8522, Japan.
Department of Hematology, Japanese Red Cross Ishinomaki Hospital, Miyagi, Japan.
BMC Nephrol. 2018 Nov 8;19(1):312. doi: 10.1186/s12882-018-1125-9.
Rapid decline in renal dysfunction due to primary renal lymphoma, or secondary renal lymphoma by infiltration from a primary origin, is extremely rare. There are notably few reports indicating infiltration of T-cell lymphoma into the kidney.
A 61-year-old woman with a sudden body rash and liver dysfunction was brought to our hospital presenting with a dull headache and blurred vision. Laboratory tests revealed rapidly progressive renal failure. Histological examination of the kidney and skin indicated infiltration of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). Infiltration of PTCL-NOS to the liver and spleen, and presence of Uveitis masquerade syndrome were suspected. Imaging showed that the lesion was limited to extralymphatic organs. Renal function was improved with administration of steroids, including pulse steroid therapy, before administering cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) therapy.
This is the first reported case of rapidly progressive renal failure caused by perivascular tubulointerstitial nephritis with the direct invasion of PTCL-NOS. In our case, a single steroid dose showed dramatic results with respect to renal symptoms.
原发性肾淋巴瘤或原发性起源浸润引起的继发性肾淋巴瘤导致肾功能迅速下降极为罕见。鲜有报道表明 T 细胞淋巴瘤浸润肾脏。
一名 61 岁女性因突发皮疹和肝功能异常被送往我院，伴有钝痛性头痛和视力模糊。实验室检查显示肾功能迅速恶化。肾脏和皮肤的组织学检查提示为外周 T 细胞淋巴瘤，非特指型（PTCL-NOS）。疑似存在肝脾浸润的 PTCL-NOS 和葡萄膜炎伪装综合征。影像学检查显示病变局限于结外器官。在给予环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）治疗前，通过给予类固醇（包括脉冲类固醇治疗）改善了肾功能。
这是首例由 PTCL-NOS 直接侵犯导致的血管周围小管间质性肾炎引起的进行性肾功能衰竭的报道。在我们的病例中，单次类固醇剂量对肾脏症状有显著效果。
