Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Thorac Cancer. 2019 Oct;10(10):2035-2039. doi: 10.1111/1759-7714.13171. Epub 2019 Aug 26.
A 63-year-old man presented to our clinic complaining of cough and exertional dyspnea. He was diagnosed with dermatomyositis-associated interstitial lung disease (DM-ILD) with typical rashes, an elevated creatine kinase level and chest high-resolution computed tomography (CT) manifestations. His symptoms and lung shadows improved after treatment with corticosteroids, immunosuppressants and pirfenidone, although his serum creatine kinase level remained elevated. An expanding nodule in the lower left lung and lymphadenopathy in the right cardiophrenic angle were visible on the repeated chest CT scan during follow-up approximately one year later. Empirical antibiotics had no effect. A positron emission tomography-computed tomography (PET-CT) scan showed an increased standard uptake value (SUV) in the newly emerged pulmonary nodule, mediastinal lymphadenopathy and multiple hepatic masses. He was diagnosed with diffuse large B-cell lymphoma following liver biopsy. After eight cycles of rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy, the lymphoma was cured clinically, and his interstitial lung disease (ILD) had improved. Tumor surveillance should be performed during DM-ILD follow-up, and rituximab could be a promising choice for DM-ILD concurrent with lymphoma.
一位 63 岁男性因咳嗽和活动后呼吸困难到我院就诊。他被诊断为皮肌炎相关间质性肺病（DM-ILD），伴有典型皮疹、肌酸激酶水平升高和胸部高分辨率计算机断层扫描（CT）表现。他的症状和肺部阴影在接受皮质类固醇、免疫抑制剂和吡非尼酮治疗后得到改善，尽管他的血清肌酸激酶水平仍升高。大约一年后随访时的胸部 CT 扫描显示左下肺的一个进行性结节和右心膈角的淋巴结病。经验性抗生素治疗无效。正电子发射断层扫描-计算机断层扫描（PET-CT）扫描显示新出现的肺结节、纵隔淋巴结病和多个肝肿块的标准摄取值（SUV）增加。肝活检后诊断为弥漫性大 B 细胞淋巴瘤。在接受 8 个周期的利妥昔单抗-环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）化疗后，淋巴瘤在临床上得到治愈，间质性肺病（ILD）也得到改善。在 DM-ILD 随访期间应进行肿瘤监测，利妥昔单抗可能是 DM-ILD 合并淋巴瘤的一个有前途的选择。
