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Vol. 14. Issue 6.
Pages 857-868 (November - December 2008)
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Vol. 14. Issue 6.
Pages 857-868 (November - December 2008)
Caso Clínico/Case Report
Open Access
Linfoma intravascular do pulmão: A propósito de um caso clínico com boa resposta à terapêutica
Intravascular pulmonary lymphoma with good response to treatment. A case report
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M. Felizardo1,
Corresponding author
margaridafelizardo@yahoo.com

Correspondência / Correspondence to: Margarida Felizardo, Hospital de Santa Maria CHNL, EPE, Avenida Prof. Egas Moniz, Lisboa, Portugal
, A.C. Mendes2, A. Fernandes3, P. Campos4, V. Magalhães2, I. Correia2, A. Pignatelli5, C. Ferreira6, R. Sotto-Mayor7, A Bugalho de Almeida8
1 Interna do Internato Complementar de Pneumologia / Resident, Specialist training in Pulmonology
2 Assistente Hospitalar Graduada de Pneumologia / Consultant, Pulmonology specialist
3 Director do Serviço de Anatomia Patológica. Professor Graduado da Faculdade de Medicina de Lisboa / Director, Anatomo-Pathology Unit. Specialist professor, Lisbon University School of Medicine
4 Assistente Hospitalar Graduada de Imagiologia / Consultant, Radiology specialist
5 Interna do Internato Complementar de Anatomia Patológica / Resident, Specialist training in Anatomo-Pathology
6 Assistente Hospitalar de Anatomia Patológica / Consultant, Anatomo-Pathology
7 Chefe de Serviço de Pneumologia. Assistente convidado da Faculdade de Medicina de Lisboa / Head, Pulmonology Unit. Guest assistant professor Lisbon University School of Medicine
8 Director do Serviço de Pneumologia. Professor da Faculdade de Medicina de Lisboa / Director, Pulmonology Unit, Specialist professor, Lisbon University School of Medicine
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Resumo

O linfoma intravascular é uma forma muito rara de linfoma não Hodgkin de células grandes B. Caracte-riza-se pela proliferação celular tumoral de linfócitos limitada aos pequenos vasos, particularmente nos capilares. Apresentamos o caso de uma doente de 54 anos, não fumadora, que foi admitida no nosso hospital para investigação de um quadro com quatro meses de evolução de febre, sudorese nocturna, emagrecimento não quantificado e dispneia progressiva. Ao exame objectivo apresentava-se febril, taquicárdica e polipneica. Analiticamente, destacava-se anemia, leucocitose e LDH elevada. Gasometria arterial -FiO2 1l/m: PaO2-63,6mm Hg. A telerradiografia de tórax revelava infiltado intersticial difuso. Foram excluídas todas as causas de febre de origem indeterminada. O diagnóstico foi realizado por biópsia pulmonar cirúrgica e foi prescrita terapêutica citostática combinada e rituximab com boa resposta clínica. Relatamos o caso pela dificuldade diagnóstica e pela boa resposta à terapêutica.

Rev Port Pneumol 2008; XIV (6): 857-868

Palavras-chave:
Linfoma
intravascular
febre
pulmonar
Abstract

Intravascular lymphoma is a very rare form of large B cell non-Hodgkin’s lymphoma, characterised by the presence of lymphoma cells in the lumina of small vessels only, particulary in the capillaries. We report a 54 year-old female non-smoker, admitted to hospital for further examination of a four month long clinical condition involving high fever, night sweats, unqualified weight loss and progressive dyspnea. Patient’s temperature was 38.5ºC, pulse 100/min and respiratory 22 cycles/min.

Patient’s haemoglobin was 9.4g/dL, she had leukocytosis, elevated LDH and arterial blood gas analysis with moderate hypoxaemia (FiO2 1l/m: PaO2-63.6mm Hg). Chest X-ray revealed diffuse interstitial changes. All the possible causes of unknown origin fever were excluded.

Diagnosis was made through lung biopsy and treatment with combined chemotherapy and rituximab was prescribed leading to a 48 hours clinical remission. We present this case to show how difficult this diagnosis can be and how a good response to therapy is possible.

Rev Port Pneumol 2008; XIV (6): 857-868

Key-words:
Lymphoma
intravascular
fever
pulmonary
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Bilbiografia / Bibliography
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Copyright © 2008. Sociedade Portuguesa de Pneumologia/SPP
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