Lupus nephritis associated with CD20+ B-cell NHL

The combination of NHL and documented malignancy-associated glomerulonephritis is uncommon. Also, no single renal pathological entity is consistently found in patients with NHL. Epstein-Barr virus (EBV) infection may manifest as systemic lupus erythematosus (SLE) and/or diffuse large cell lymphoma (DLBCL) in a genetically/ immunologically susceptible individual with defective cytotoxic T-cell response against EBV. We describe lupus nephritis in a 45 years old male suffering from untreated NHL. CD20+ DLBCL was demonstrated by immunohistochemistry of the neck lymph node (LN) biopsy performed for generalized lymphadenopathy. Renal biopsy revealed class V + IV lupus nephritis. Serology demonstrated EBV infection. Complete clinical remission of both SLE and DLBCL was achieved post-therapy with six-cycle rituximab, cyclophosphamide, vincristin, adriablastin, methylprednisolone (R-CHOP) regime. This case report demonstrated the complex relationships between NHL, SLE, EBV and membranous glomerulonephritis. The presented case is remarkable not only because of the rare association of SLE and DLBCL, but also because of its successful treatment with R-CHOP.