Multiple autoimmune propensity and B-non-hodgkin lymphoma: cause or effect?

Area of Science:

• Hematology
• Immunology
• Oncology

Background:

• Autoimmune diseases and B-cell malignancies can share common pathogenic pathways.
• Extrahepatic B-non-Hodgkin lymphoma (B-NHL) can present with diverse clinical manifestations.

Observation:

• A 63-year-old woman presented with fatigue due to severe autoimmune hemolytic anemia (AIHA).
• Elevated IgM and γ-GT prompted testing for antimitochondrial antibodies (AMAs), which were positive for anti-M2 specificity.
• Prolonged aPTT led to the detection of antiphospholipid antibodies (APLAbs), including lupus anticoagulant.

Findings:

• Bone marrow biopsy confirmed lymphoplasmacytic B-non-Hodgkin lymphoma.
• The patient exhibited a triad of AIHA, AMAs, and APLAbs preceding the B-NHL diagnosis.
• B-NHL achieved remission, while AMAs and APLAbs remained detectable 10 months later.

Implications:

• This case highlights the potential for multiple autoimmune reactions to be presenting manifestations of B-NHL.
• Understanding the shared pathogenetic mechanisms between autoimmunity and B-NHL is crucial for diagnosis and treatment.
• Further research into the links between B-NHL and autoimmune phenomena may reveal novel therapeutic targets.