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Abstract
A 69-year-old female was referred to our institution due to abdominal pain and palpable purpura on both buttocks and legs. A skin biopsy of her purpura revealed granulocyte infiltration and leucocytoclasia around the arterioles and venuoles at the dermis, as well as an elevated serum immunoglobulin A level, hematuria and proteinuria. Therefore she was diagnosed with Henoch-Schönlein purpura. She had been diagnosed with diffuse large B cell lymphoma after a biopsy of her left inguinal lymph node 12 years ago and received 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy, which was followed by a complete remission. Abdominal and chest CT revealed multiple lymph node enlargement and bowel wall thickening at the ileocecal area, and lesions were observed in a whole body PET CT scan. Recurrence of the diffuse large B cell lymphoma was confirmed by a biopsy of the ileocecal area via colonoscopy. The purpura was improved after oral prednisolone therapy and etoposide, oxaliplatin and ifosfamide salvage combination chemotherapy was used to treat the lymphoma.
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Fig. 2
Abdominal computed tomography shows the enlargement of multiple mesenteric lymph nodes and mild thickening of bowel wall at ileocecal area.
Fig. 3.
Chest computed tomography shows supraclavicular, bilateral paratracheal, subcarinal, right hilar lymph nodes enlargement, bilateral pleural effusion and lung involvement of lymphoma at right lower lobe.
Fig. 4
Whole body positron emission tomography shows lymphoma involvement in right tonsil, both level IIA lymph nodes of the neck, left supraclavicular lymph node, lower lobe of right lung, spleen and ileocecal valve, portahepatis, portocaval, paraaortic, and aortocaval lymph nodes, lymph nodes around ileocolic artery and jejunum, retroperitoneal lymph nodes around right psoas muscle, right common iliac lymph node, right internal and external iliac lymph nodes, and both inguinal lymph nodes.
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