Virchow's node, jaundice, and weight loss--lymphoma mimicking gastrointestinal malignancy
Constantinos P Anastassiades1, Thomas H Poterucha
1Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. anastassiades.constantinos@mayo.edu
Background:
A 46-year-old white male with a history of well-controlled paranoid schizophrenia presented with painless jaundice, progressive anorexia, weight loss, and dyspnea of 3 months' duration. His only medication at presentation was the antipsychotic olanzapine, taken orally.
Investigations:
Physical examination and laboratory tests, including a complete blood cell count, electrolyte, lactate dehydrogenase and haptoglobin levels, liver function tests, and a Coombs' test; CT scan of the chest and abdomen; invasive investigations, including thoracentesis and pleural fluid analysis, bone-marrow biopsy, and left supraclavicular lymph-node biopsy.
Diagnosis:
Diffuse large B-cell lymphoma.
Management:
Large-volume thoracentesis. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy followed by dexamethasone, cytarabine, and cisplatin chemotherapy, and autologous stem-cell transplantation.
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