pituitrin and Lymphoma--Large-B-Cell--Diffuse

Topics: Humans; Hyponatremia; Inappropriate ADH Syndrome; Lymphoma, Large B-Cell, Diffuse; Vasopressins

A 61-year-old woman presented with a right mandibular tumor and was diagnosed with DLBCL clinical stage IIIA from the biopsy results of the tumor and CT examination. An initial rituximab was administrated a week after the first CHOP treatment. During the infusion of rituximab, she exhibited disorientation, seizure, and consciousness disturbance. Hyponatremia due to SIADH and hypertension were coincidentally observed. MRI revealed T2 and FLAIR hyperintense signals involving the bilateral occipital, parietal, frontal lobes and the cerebellum that were consistent with reversible posterior leukoencephalopathy syndrome (RPLS). Her consciousness level recovered in parallel with corrections in serum sodium levels and blood pressure. Although she presented with transient cortical blindness, all neurological abnormalities disappeared 40 hours after the occurrence of seizure. She received a further 7 cycles of CHOP followed by 7 cycles of rituximab treatment with no relapse of RPLS. After irradiation for a residual abdominal tumor, she has maintained complete remission for 2 years. Although RPLS is a rare complication of rituximab-CHOP chemotherapy, it should be considered in patients with DLBCL who present with acute neurological deterioration.

Topics: Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Brain; Cyclophosphamide; Doxorubicin; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Magnetic Resonance Imaging; Middle Aged; Neurophysins; Posterior Leukoencephalopathy Syndrome; Prednisone; Protein Precursors; Rituximab; Vasopressins; Vincristine

The Asian variant of intravascular large B cell lymphoma is a special type of intravascular lymphoma with hemophagocytic syndrome and hypercytokinemia including interleukin-6, which stimulates antidiuretic hormone synthesis in the hypothalamus. We present here that the syndrome of inappropriate antidiuretic hormone secretion frequently occurs in patients with the Asian variant of intravascular large B cell lymphoma. The syndrome of inappropriate antidiuretic hormone secretion was found in eight of 118 (6.8%) lymphoma patients at the first diagnosis. Although there were six (5.1%) among 118 lymphoma patients with the Asian variant of intravascular large B cell lymphoma, four of the six patients (66.7%) developed the syndrome of inappropriate antidiuretic hormone secretion. In four patients with the Asian variant of intravascular large B cell lymphoma with the syndrome of inappropriate antidiuretic hormone secretion, elevated serum interleukin-6 and low sodium levels were almost normalized after chemotherapy. The Asian variant of intravascular large B cell lymphoma patients frequently develop the syndrome of inappropriate antidiuretic hormone secretion, and interleukin-6 might play a role in the occurrence of this disease. We should pay attention to hyponatremia caused by the syndrome of inappropriate antidiuretic hormone secretion in patients with the Asian variant of intravascular large B cell lymphoma.

Topics: Adult; Aged; Aged, 80 and over; Asia; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Interleukin-6; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Sodium; Syndrome; Vasopressins; Young Adult

Topics: Female; Humans; Hyponatremia; Lymphoma, Large B-Cell, Diffuse; Middle Aged; Tonsillar Neoplasms; Vasopressins; Vincristine

Topics: Astrocytoma; Brain Neoplasms; Cysts; Epidermal Cyst; Glioblastoma; Humans; Hypothalamo-Hypophyseal System; Lymphoma, Large B-Cell, Diffuse; Meningioma; Neuroectodermal Tumors, Primitive, Peripheral; Oligodendroglioma; Pituitary Gland, Posterior; Vasopressins