(b) Atypical cells with mitosis (*) (Hematein-eosin �� 40). (c) Staining with anti-CD20 (��40): atypical cells are stained. (d) Staining … Figure 3 Pulmonary localisation of lymphomatoid granulomatosis. Transverse CT view, with contrast injection in parenchymatous window showing nodular lesions taking normally contrast. (a) At initial diagnosis. (b) 2 years after reduction in the immunosuppression and rutiximab … Two months following immunosuppression reduction, the lesions were persistently unchanged. A treatment by anti-CD20 antibodies was then initiated (Rituximab: 375mg/m2 weekly for 4 weeks). Markedly, after the first two doses, a significant clinical improvement was noted. The tolerance of rituximab was good. Six months later, the patient reported a complete disappearance of headache and a significant regression of gait disorders.
Two years later (December 2007), there was no clinical sign of recurrence, the renal function was stable, and the brain MRI showed the persistence of hypersignals and infarction Inhibitors,Modulators,Libraries zones remnants. Inhibitors,Modulators,Libraries The thoracic CT scan showed only a single nodule (Figure 3(b)). The immunosuppressive treatment consisted of tacrolimus 1mg/d and prednisone 0.2mg/kg/d. The last thoracic Inhibitors,Modulators,Libraries and brain CT scans (February Inhibitors,Modulators,Libraries 2010) showed a complete disappearance of the pulmonary and cerebral lesions. Laboratory results revealed creatinine level 1.1mg/dL (101��mol/L), negative proteinuria, normal LDH level, and negative EBV plasmatic PCR. Immunophenotyping of blood lymphocytes revealed low CD19 count (10/mm3). 3. Discussion This paper highlights the diagnostic and therapeutic difficulties of LYG.
Our patient presented many risk factors of this disease including: age, immunosuppression, administration of antilymphocyte sera for her two renal transplants, and the Inhibitors,Modulators,Libraries reactivation of CMV. The clinical presentation demonstrated the heterogenecity and the abundance of the symptoms. It should be noted a clinicoradiological delay for the diagnosis of pulmonary lesions. Our therapeutic approach was sequential, initially by a reduction in the immunosuppression, then rituximab was introduced. 3.1. Frequency LYG is a rare disorder belonging to the group of type B lymphoproliferative diseases. It affects males > females (2 men for 1 woman) and affects primarily immunocompromised patients. The peaks of frequency concern 3rd and 6th decades [5, 6].
Patients presenting LYG have 10 to 60% risk to develop large B cells lymphoma. LYG is a serious disorder with a median survival of 2 years in the general population. The main cause GSK-3 of death is the progression of pulmonary lesions . In renal transplantation, the literature reported 6 cases among which 3 cases were diagnosed postmortem and 3 other cases with good outcome (one case after a reduction in immunosuppression, 2 cases after chemotherapy) [1, 2, 8�C11]. 3.2.