Lymphomatoid Granulomatosis


ABSTRACT:

Lymphomatoid granulomatosis is a rare disorder and a form of non-Hodgkin’s lymphoma. This disease engages the lung, skin, kidneys, liver, nervous system and adrenal gland. From a clinical and radiological perspective, it is similar to collagen vascular diseases, lung abscess, and metastatic disease and is difficult to diagnose. The present report introduces a case with diagnostic challenges. Introducing the case The patient was a non-smoker 63-year-old man referred from a skin clinic due to arthralgia. He complained of pain in elbow, wrist, and knee joints, intensifying at night times, with a non-inflammatory nature. He was complaining of skin lesions on his leg and arms. A skin biopsy was performed. He had a hospitalization record due to pulmonary problems two months earlier in another center, which was treated as pneumonia. He was under hydroxychloroquine treatment due to skin lesions. He did not mention a history of other diseases. A physical examination showed patch and plaques in the legs and arms, while other organs were normal. 


To rule out the collagen vascular diseases, the following laboratory tests were requested: CBC diff, ANA, RF, Anticcp, ANCA, ACE Level, HBSAg, HCVAb, HIVAb, LFT, Cr, CPK, Aldolase, PSA, which were normal. LDH; 500U/L (NL;207-414)mg/L , ESR; 40mm/h, CRP; NL, Urine Analysis; NL. The skin biopsy of leg lesions reported lymphohistiocytic infiltration in the upper and deep dermis and subcutis. Some histocytes in the upper dermis were surrounded by collagen fibers, and the final diagnosis of the skin lesions was granulomaannulare. Considering the recent pulmonary problems and the likelihood of paraneoplastic process, despite the normal results of the chest radiography, the CT scans of the chest, abdomen, and pelvis were requested. Numerous scattered interstitial nodules with distinct and smooth borders were observed in both lungs, with the biggest ones in the right and left lungs, 20×35 mm and 20 mm, respectively. An adenopathy 15 mm in diameter existed in the middle mediastinum.

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