Korean J Hematol.  2007 Jun;42(2):162-166. 10.5045/kjh.2007.42.2.162.

A Case of Henoch-Schonlein Purpura Associated with Diffuse Large B Cell Lymphoma

• Kim ID
• Lee SG
• Lee HJ
• Jo WS
• Choi YJ
• Shin HJ
• Chung JS
• Cho GJ
• Lee EY

• KMID: 2083515
• DOI: http://doi.org/10.5045/kjh.2007.42.2.162

Abstract

A 69-year-old female was referred to our institution due to abdominal pain and palpable purpura on both buttocks and legs. A skin biopsy of her purpura revealed granulocyte infiltration and leucocytoclasia around the arterioles and venuoles at the dermis, as well as an elevated serum immunoglobulin A level, hematuria and proteinuria. Therefore she was diagnosed with Henoch-Schonlein purpura. She had been diagnosed with diffuse large B cell lymphoma after a biopsy of her left inguinal lymph node 12 years ago and received 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy, which was followed by a complete remission. Abdominal and chest CT revealed multiple lymph node enlargement and bowel wall thickening at the ileocecal area, and lesions were observed in a whole body PET CT scan. Recurrence of the diffuse large B cell lymphoma was confirmed by a biopsy of the ileocecal area via colonoscopy. The purpura was improved after oral prednisolone therapy and etoposide, oxaliplatin and ifosfamide salvage combination chemotherapy was used to treat the lymphoma.

Keyword

Henoch-Schonlein purpura; Diffuse large B cell lymphoma; Malignancy; Vasculitis

MeSH Terms

Abdominal Pain
Aged
Arterioles
Biopsy
Buttocks
Colonoscopy
Dermis
Doxorubicin
Drug Therapy
Drug Therapy, Combination
Etoposide
Female
Granulocytes
Hematuria
Humans
Ifosfamide
Immunoglobulin A
Leg
Lymph Nodes
Lymphoma
Lymphoma, B-Cell*
Prednisolone
Proteinuria
Purpura
Purpura, Schoenlein-Henoch*
Recurrence
Skin
Tomography, X-Ray Computed
Vasculitis
Vincristine
Doxorubicin
Etoposide
Ifosfamide
Immunoglobulin A
Prednisolone
Vincristine

Figure

• 

  Fig. 1 Cutaneous finding shows multiple palpable purpura on both legs.

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  Fig. 2 Abdominal computed tomography shows the enlargement of multiple mesenteric lymph nodes and mild thickening of bowel wall at ileocecal area.

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  Fig. 3. Chest computed tomography shows supraclavicular, bilateral paratracheal, subcarinal, right hilar lymph nodes enlargement, bilateral pleural effusion and lung involvement of lymphoma at right lower lobe.

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  Fig. 4 Whole body positron emission tomography shows lymphoma involvement in right tonsil, both level IIA lymph nodes of the neck, left supraclavicular lymph node, lower lobe of right lung, spleen and ileocecal valve, portahepatis, portocaval, paraaortic, and aortocaval lymph nodes, lymph nodes around ileocolic artery and jejunum, retroperitoneal lymph nodes around right psoas muscle, right common iliac lymph node, right internal and external iliac lymph nodes, and both inguinal lymph nodes.

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  Fig. 5 Pathologic finding of skin biopsy shows neutrophils infiltration and leucocytoclasia around arterioles and venuoles at dermis (H&E, ×400).

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  Fig. 6 Pathologic finding of ileocecal area biopsy via colonoscopy shows atypical lymphoid cell proliferation in lamina propria (A: H&E, ×200) and large neoplastic cells with vesicular nuclei (B: H&E, ×400).

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