抄録
A case of adult T-cell type lymphoma with generalized cytomegalovirus infection and pneumocystis carinii pneumonia is reported. A 39-year-old man with lymphosarcoma (lymphocytic, poorly differentiated) who had received fifteen courses of VEMP therapy (vincristine, endoxan, 6 MP, prednisolone) and recurred. He was admitted to our hospital because of general lymphadenopathy and hepatomegaly. On admission, he was complicated with hypercalcemia. The administration of calcitonin was not effective for hypercalcemia and subsequently he was treated with adriamycin, bleomycin and prednisolone (ABP). After 30 mg administration of bleomycin in a total dose, a slightly exertional dyspnea was appeared and chest X-ray revealed light snow-like shadow and increased pulmonary markings. Dyspnea was gradually increased and he died because of respiratory disturbance one month later. At autopsy diffuse cytomegalovirus infection of the lungs (weight: 710, 780 g) and multiple cytomegalic inclusion bodies in the alveolar cells were found. Cytomegalovirus in the nucleus and cytoplasma of the alveolar cells in the lungs was identified electron microscopically. Scattered and microscopical foci with large cells with cytomegalic inclusion bodies in the liver, and cytomegalovirus-infected cells in the glomerular tufts of the kidneys and the mediastinal lymph nodes were seen. Severe and diffuse pneumocystis carinii pneumonia of the lungs was superimposed. Marked calcium deposition in the tubular and interstitium of the kidneys was seen, and parathyroid had morphologically non-remarkable change. T-cell lymphoma had poor prognosis and shorter duration of survival because of accompanying more frequent incidences of opportunistic infection and other complications, such as interstitial pneumonitis and hypercalcemia. Significant improvement in survival of T-cell type lymphoma will not be seen until management for these opportunistic infection is improved.
