linfoma intravascular do pulmão: a propósito de um caso clÃnico com boa resposta à terapêutica
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ID: 190983
2008
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Abstract
Resumo: O linfoma intravascular é uma forma muito rara de linfoma não Hodgkin de células grandes B. Caracte-riza-se pela proliferação celular tumoral de linfócitos limitada aos pequenos vasos, particularmente nos capilares. Apresentamos o caso de uma doente de 54 anos, não fumadora, que foi admitida no nosso hospital para investigação de um quadro com quatro meses de evolução de febre, sudorese nocturna, emagrecimento não quantificado e dispneia progressiva. Ao exame objectivo apresentava-se febril, taquicárdica e polipneica. Analiticamente, destacava-se anemia, leucocitose e LDH elevada. Gasometria arterial -FiO2 1 l/m: PaO2-63,6 mm Hg. A telerradiografia de tórax revelava infiltado intersticial difuso. Foram excluÃdas todas as causas de febre de origem indeterminada. O diagnóstico foi realizado por biópsia pulmonar cirúrgica e foi prescrita terapêutica citostática combinada e rituximab com boa resposta clÃnica. Relatamos o caso pela dificuldade diagnóstica e pela boa resposta à terapêutica.Rev Port Pneumol 2008; XIV (6): 857-868 Abstract: Intravascular lymphoma is a very rare form of large B cell non-Hodgkinâs lymphoma, characterised by the presence of lymphoma cells in the lumina of small vessels only, particulary in the capillaries. We report a 54 year-old female non-smoker, admitted to hospital for further examination of a four month long clinical condition involving high fever, night sweats, unqualified weight loss and progressive dyspnea. Patientâs temperature was 38.5 ºC, pulse 100/min and respiratory 22 cycles/min.Patientâs haemoglobin was 9.4 g/dL, she had leukocytosis, elevated LDH and arterial blood gas analysis with moderate hypoxaemia (FiO2 1 l/m: PaO2-63.6 mm Hg). Chest X-ray revealed diffuse interstitial changes. All the possible causes of unknown origin fever were excluded.Diagnosis was made through lung biopsy and treatment with combined chemotherapy and rituximab was prescribed leading to a 48 hours clinical remission. We present this case to show how difficult this diagnosis can be and how a good response to therapy is possible.Rev Port Pneumol 2008; XIV (6): 857-868 Palavras-chave: Linfoma, intravascular, febre, pulmonar, Key-words: Lymphoma, intravascular, fever, pulmonary
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felizardo2008revistalinfoma
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| Authors | ;M. Felizardo;A.C. Mendes;A. Fernandes;P. Campos;V. Magalhães;I. Correia;A. Pignatelli;C. Ferreira;R. Sotto-Mayor;A Bugalho de Almeida |
| Journal | the journal of applied psychology |
| Year | 2008 |
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