CAD Diagnosis Seen With Diffuse Large B-cell Lymphoma: Case Report
The case of a man with cold agglutinin disease (CAD) that was found to be secondary to a blood cancer, called diffuse large B-cell lymphoma (DLBCL), was described in a recent report.
The researcher proposes that DLBCL should be considered as a potential diagnosis in people with unexplained CAD.
The report, “Bone marrow and peripheral blood involvement of relapsed diffuse large B-cell lymphoma after prior cold agglutinin disease,” was published in the International Journal of Laboratory Hematology.
Soon Hee Chang, MD, at Kyungpook National University, Republic of Korea, described the case of a 64-year-old man who sought medical attention due to headache and generalized weakness.
The man had a prior history of DLBCL, a type of cancer caused by the uncontrolled growth of immune cells called B-cells. Five years earlier, a DLBCL tumor had formed in the man’s testis, and he underwent chemotherapy and radical orchiectomy — a surgery to remove the testis — to treat it. His condition had remained stable before he began to complain of general weakness and headache.
Laboratory tests showed he had anemia, or abnormally low levels of the red blood cells that carry oxygen through the bloodstream to the body’s tissues. He also tested positive for the self-targeting antibodies that drive CAD, leading to a CAD diagnosis.
A year after being diagnosed, a lymph node in the man’s neck became enlarged and was biopsied. Results indicated he had suffered a recurrence of DLBCL.
Tests showed the cancer was in the man’s bone marrow — the spongy tissue inside bones where new blood cells, including B-cells, are produced — and in the blood circulating throughout his body, called peripheral blood.
Other laboratory tests were similar to those from the year before, including those confirming CAD was still present.
“The diagnosis was lymphoma with [bone marrow] and [peripheral blood] involvement and co-occurring [CAD],” Chang wrote.
Although CAD occurring secondary to lymphoma has been reported before, “cases of [bone marrow] involvement with CAD are quite rare and no case of [peripheral blood] invasion with CAD have been reported,” Chang wrote. “Because of these findings, the differential diagnosis of patients with CAD should include DLBCL, considering the possibility of [bone marrow] or even [peripheral blood] involvement.”