Watanabe Kohei, Harada Naonori, Shibano Ikumi, Izuta Yuto, Mukai Daiki, Kizawa Yusuke, Shiragami Hiroshi, Mugitani Atsuko
Junior Resident, Fuchu Hospital.
Department of Hematology, Fuchu Hospital.
Rinsho Ketsueki. 2024;65(5):335-339. doi: 10.11406/rinketsu.65.335.
A 69-year-old woman was previously treated with antibiotics for suspected pyelonephritis due to fever but showed limited improvement. Contrast-enhanced CT revealed heterogeneous areas of decreased contrast enhancement in both kidneys, along with an elevated soluble level of the IL-2 receptor (5,090 U/ml), and thus the patient was referred to our department for further evaluation. A percutaneous renal biopsy performed due to suspected malignant lymphoma confirmed lymphoma cell infiltration into the renal interstitium. Immunohistochemical staining was positive for MYC/BCL2/BCL6, leading to the diagnosis of stage IVB primary renal triple expressor diffuse large B cell lymphoma (DLBCL). Due to acute kidney injury, continuous hemodiafiltration (CHDF) was initiated, followed by rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. The patient's renal function improved rapidly, and complete response was achieved after six cycles of R-CHOP. Although DLBCL is a common lymphoma, the primary renal subtype is extremely rare and poses both diagnostic and therapeutic challenges. This case highlights the potential clinical implications of combining CHDF with chemotherapy to achieve complete response despite an initial poor prognosis based on the patient's overall clinical condition and pathology.
一名69岁女性因发热曾因疑似肾盂肾炎接受抗生素治疗，但改善有限。增强CT显示双肾造影剂增强区域不均匀减少，同时白细胞介素-2受体可溶性水平升高（5,090 U/ml），因此该患者被转诊至我科进一步评估。因疑似恶性淋巴瘤进行的经皮肾活检证实淋巴瘤细胞浸润至肾间质。免疫组化染色MYC/BCL2/BCL6呈阳性，诊断为IVB期原发性肾三表达弥漫大B细胞淋巴瘤（DLBCL）。由于急性肾损伤，开始进行连续性血液透析滤过（CHDF），随后进行利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）化疗。患者肾功能迅速改善，R-CHOP六个周期后达到完全缓解。尽管DLBCL是一种常见的淋巴瘤，但原发性肾亚型极为罕见，在诊断和治疗方面都具有挑战性。该病例突出了根据患者的整体临床状况和病理情况，尽管初始预后较差，但将CHDF与化疗相结合以实现完全缓解的潜在临床意义。
