Diffuse large cell lymphoma presenting as a sacral mass and lupus anticoagulant

Area of Science:

• Hematology
• Oncology
• Immunology

Background:

• Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent thrombosis or pregnancy morbidity.
• Lymphoid neoplasms can occasionally be associated with autoimmune phenomena, but the direct link with APS is less commonly reported.

Observation:

• A 67-year-old male presented with a supratherapeutic INR and a sacral lesion.
• Laboratory findings revealed elevated inflammatory markers, prolonged clotting times (PT, PTT, INR), and a positive Russell Viper Venom Test (RVVT), confirming lupus anticoagulant (LA) and diagnosing antiphospholipid syndrome (APS).
• Histopathology of the sacral lesion identified diffuse large B-cell lymphoma.

Findings:

• This case presents a unique association between APS and diffuse large B-cell lymphoma, contrasting with typical presentations of APS and lymphoid malignancies.
• The patient's presentation included elevated PT and PTT, which differs from other reported cases.
• Treatment with Rituximab-CHOP chemotherapy resulted in complete tumor remission and normalization of PT and PTT, indicating resolution of both conditions.

Implications:

• This case highlights the complex interplay between autoimmune disorders like APS and hematologic malignancies.
• The successful treatment outcome suggests Rituximab-CHOP chemotherapy may be an effective therapeutic strategy for patients with concurrent APS and diffuse large B-cell lymphoma.
• Further research is warranted to elucidate the pathogenic mechanisms underlying the association between APS and lymphoid neoplasms and to optimize treatment protocols.