Abstract
A 43 year-old man visited our hospital complaining of blurred vision, and uveitis was diagnosed in February 1981. A tuberculin skin test was positive. Prednisolone was administrated, and the uveitis subsided. As fever and cervical lymphadenopathy developed, he was admitted to our hospital in November 1981. Although the chest X-ray showed no abnormality, a diagnosis of sarcoidosis was made because of uveitis, negative conversion of the tuberculin skin test, elevation of serum ACE and non-caseating epitheloid cell granuloma seen in a cervical lymph node biopsy specimen. Prednisolone (30mg per day) was prescribed and fever subsided. But in July 1982, high intermittent fever recurred. As chest X-ray revealed mediastinal widening and left hilar lymphadenopathy, he was hospitalized again. Laboratory findings showed liver dysfunction and further elevation of serum ACE levels. In spite of prednisolone therapy, jaundice, bilateral pleural effusions and ascites developed, and his general condition deteriorated rapidly. A cervical lymph node was biopsied again and re-evaluated together with the previous specimen. Then the case was diagnosed as so-called Lennert's lymphoma. Study of the surface markers of the lymph node cells revealed an increase of E rosettepositive and OKT-8 positive cells, which indicated T cell monoclonal proliferation. Combination chemotherapy consisting of cyclophosphamide, vincristine, procarbazine and prednisolone was started, and soon he was afebrile. Serum ACE levels and liver dysfunction gradually improved. He has been in complete remission for one year.
It is interesting that the various clinical findings in this case resembled those seen in sarcoidosis. We considered it was a systemic sarcoid reaction in which lymphoma cells might participate.
