A 53-year-old man was referred to our hospital because of fever and cytopenia for 2 months. He went to a local hospital initially. Laboratory tests showed Hb 83 g/L, PLT count 53 x 109/L, and serum globulin 68.8 g/L. The T-SPOT test was positive. Ultrasound examination revealed right pleural effusion, abdominal effusion, and generalized lymphadenopathy. No acid-fast bacilli or malignant tumor cells were found in ascites. Fine-needle aspiration (FNA) biopsy of left cervical LN was negative. He received a diagnostic antituberculosis therapy, which suspended in the fifth day due to sudden high fever, and pleural effusion was increased. Thereafter, he went to the tuberculosis specialist hospital, and no acid-fast bacilli were found in the pleural and ascites effusion. Finally, two months later, after clinical symptoms appear, he was referred to our hospital. Laboratory tests showed WBC 6.8 x 109/L, Hb 53 g/L, and PLT count 42 x 109/L. Serum globulin was more than 100 g/L. SPEP and IFE demonstrated polyclonal hypergammaglobulinemia (IgA 14.7 g/L, IgG 89.4 g/L, IgM 6.73 g/L, and IgG4 4.96 g/L) and Coomb's test was positive. Human immunodeficiency virus, sera cytomegalovirus, hepatitis B serology, and hepatitis C serology were negative. Plasma EBV DNA was 1.19 x 103 copies/ml, and seven days later, it was quantified by qRT-PCR as 3.768 x 106 copies/2.0 x 105 cells, EBV-infected B cells. Symptomatic treatment of anti-infection, red blood cell transfusion, and plasma exchange was failed to prevent disease progression.
LN immunohistochemistry revealed tumor cells with CD3, CD5, PD1, and BCL2 positive and CD10 negative, suggesting AITL, which was verified by ancillary examinations results. The results of this patient's examination are shown in Table 1 and Figure 2. A diagnosis of AITL was established, and the patient received a cycle of R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Serum globulin was decreased to 84.8 g/L on the fourth day of chemotherapy. However, polyserous effusions and serum globulin levels had not been improved. The blood coagulation disorder is worse than before, and the performance of disseminated intravascular coagulation (DIC) appears. Ultimately, the patient abandoned treatment and discharged.