Primary hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma associated with azathioprine immunosuppression: a case report
Abstract Background Hepatic masses are relatively common findings, and the diagnostic approach often begins by identifying patient and mass characteristics that are risk factors for malignancy. Chronic immunosuppression is a known risk factor for various malignancies, and azathioprine in particular...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-023-03907-z |
| _version_ | 1797832079845621760 |
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| author | Paulina S. Marell Min Shi Majken T. Wingo |
| author_facet | Paulina S. Marell Min Shi Majken T. Wingo |
| author_sort | Paulina S. Marell |
| collection | DOAJ |
| description | Abstract Background Hepatic masses are relatively common findings, and the diagnostic approach often begins by identifying patient and mass characteristics that are risk factors for malignancy. Chronic immunosuppression is a known risk factor for various malignancies, and azathioprine in particular has been reported in association with solid and hematologic malignancies, including diffuse large B-cell lymphoma. Case presentation A 46-year-old white woman presented to clinic with several weeks of gastrointestinal symptoms and was found to have a hepatic mass on imaging. Her history was notable for neuromyelitis optica spectrum disorder on chronic immunosuppression with azathioprine. It was initially thought to be an inflammatory adenoma. On 6-month follow-up imaging, the mass had grown rapidly in size and was surgically resected. Further workup determined the mass to be an iatrogenic immunodeficiency-associated Epstein–Barr virus-positive diffuse large B-cell lymphoma confined to the liver. Azathioprine was discontinued and the patient underwent treatment with rituximab with no evidence of recurrence 2 years after the initiation of treatment. Conclusions This case report describes the first time hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma has been reported with azathioprine, which highlights the unique sequelae of chronic immunosuppression, including atypical hematologic malignancies, and the importance of considering chronic immunosuppression in the diagnostic evaluation of a hepatic mass. |
| first_indexed | 2024-04-09T14:02:01Z |
| format | Article |
| id | doaj.art-4515a4b97ada4abf8a9cefd8b4dbe6fb |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-09T14:02:01Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-4515a4b97ada4abf8a9cefd8b4dbe6fb2023-05-07T11:14:15ZengBMCJournal of Medical Case Reports1752-19472023-05-011711610.1186/s13256-023-03907-zPrimary hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma associated with azathioprine immunosuppression: a case reportPaulina S. Marell0Min Shi1Majken T. Wingo2Department of Medicine, Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo ClinicDepartment of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo ClinicDepartment of Medicine, Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo ClinicAbstract Background Hepatic masses are relatively common findings, and the diagnostic approach often begins by identifying patient and mass characteristics that are risk factors for malignancy. Chronic immunosuppression is a known risk factor for various malignancies, and azathioprine in particular has been reported in association with solid and hematologic malignancies, including diffuse large B-cell lymphoma. Case presentation A 46-year-old white woman presented to clinic with several weeks of gastrointestinal symptoms and was found to have a hepatic mass on imaging. Her history was notable for neuromyelitis optica spectrum disorder on chronic immunosuppression with azathioprine. It was initially thought to be an inflammatory adenoma. On 6-month follow-up imaging, the mass had grown rapidly in size and was surgically resected. Further workup determined the mass to be an iatrogenic immunodeficiency-associated Epstein–Barr virus-positive diffuse large B-cell lymphoma confined to the liver. Azathioprine was discontinued and the patient underwent treatment with rituximab with no evidence of recurrence 2 years after the initiation of treatment. Conclusions This case report describes the first time hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma has been reported with azathioprine, which highlights the unique sequelae of chronic immunosuppression, including atypical hematologic malignancies, and the importance of considering chronic immunosuppression in the diagnostic evaluation of a hepatic mass.https://doi.org/10.1186/s13256-023-03907-zLymphomaImmunosuppressionAzathioprineCase report |
| spellingShingle | Paulina S. Marell Min Shi Majken T. Wingo Primary hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma associated with azathioprine immunosuppression: a case report Journal of Medical Case Reports Lymphoma Immunosuppression Azathioprine Case report |
| title | Primary hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma associated with azathioprine immunosuppression: a case report |
| title_full | Primary hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma associated with azathioprine immunosuppression: a case report |
| title_fullStr | Primary hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma associated with azathioprine immunosuppression: a case report |
| title_full_unstemmed | Primary hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma associated with azathioprine immunosuppression: a case report |
| title_short | Primary hepatic Epstein–Barr virus-positive diffuse large B-cell lymphoma associated with azathioprine immunosuppression: a case report |
| title_sort | primary hepatic epstein barr virus positive diffuse large b cell lymphoma associated with azathioprine immunosuppression a case report |
| topic | Lymphoma Immunosuppression Azathioprine Case report |
| url | https://doi.org/10.1186/s13256-023-03907-z |
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