抄録
A case of B-cell malignant lymphoma associated with high titer of cold haemagglutinin (IgG-IgM mixed type) was reported. The patient was 60-year-old male whose chief complaints were fever, anemia, and epigastral discomfort. On admission, generalized lymphadenopathy, splenomegaly and mild jaundice were pointed out. Laboratory examinations revealed normochromic anemia (Hb 5.7g/dl) with erythroid marrow and elevated indirect bilirubin (1.5 mg/dl). Serum haptoglobin was 70.8 mg/dl. The direct Coombs test was positive and haemagglutination was intensed at 4°C particularly by anti-IgM antiserum and to lesser extent, by anti-IgG antiserum. The patient's serum agglutinated adult O-type RBC as well as RBC from cord blood. The biopsy of right inguinal lymphnode revealed poorly differentiated lymphoma. Population of EAC-and E rosette forming cells in this lymphnode were 10% and 9%, respectively. By cytotoxicity test with anti-B cell specific antiserum, 90% of these lymphocytes were positive. Most of cells in this lymphnode were stained with anti-B cell specific antiserum and anti-IgM antiserum using indirect immunofluorecent methods. Furthermore, the extracts of the lymphnode was demonstrated to agglutinate O-type RBC by indirect Coombs test using anti-IgM antiserum and this fact indicated that the cold haemagglutinin in this patient's serum was derived from the lymphoma tissues themselves.
The patient was treated with combination of Vincristin, Endoxan, 6MP, and Predonisolone (VEMP), and the clinical symptoms and lymphnode enlargement were remarkably subsided. At 12th day after the initiation of VEMP therapy, patient died of sudden massive bleeding due to multiple penetrating ulcers of the stomach.
