CTICasesIatrogenic Immunodeficiency-Associated Lymphoma
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Imaging findings
Initial CT from 2006 demonstrates bilateral hilar and mediastinal lymphadenopathy and perilymphatic nodules consistent with sarcoidosis. Follow-up CT in 2008 reveals a new, rapidly growing, large mass in the right middle lobe. Pathology of the resected mass demonstrated an EBV-positive Non-Hodgkin's lymphoma. The patient had a history of Crohn's disease and had been on long-term immunosuppression with methotrexate and 6-mercaptopurine.
Key takeaways
Patients undergoing long-term immunosuppressive therapy for chronic inflammatory or autoimmune diseases (such as Crohn's disease or rheumatoid arthritis) are at an increased risk of developing iatrogenic immunodeficiency-associated lymphoproliferative disorders and lymphomas. These lymphomas are frequently associated with Epstein-Barr virus (EBV) infection and can manifest as rapidly growing, focal pulmonary or mediastinal masses mimicking progressive sarcoidosis or other granulomatous diseases.
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