Digital Gangrene: An Unusual Manifestation of Non-Hodgkin Lymphoma
Background. Non-Hodgkin lymphomas (NHLs) comprise a group of haematologic malignancies with different histologic subtypes. The clinical picture varies from indolent to aggressive presentation and nodal (lymphadenopathy) to extranodal (central nervous system, gastrointestinal, cutaneous plaque, or ul...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Case Reports in Vascular Medicine |
| Online Access: | http://dx.doi.org/10.1155/2022/8963753 |
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| author | Muhammad Shoaib Momen Majumder Shamim Ahmed Tajkia Haque Syed Atiqul Haq Saumitra Chakravarty Md. Abu Shahin Din-E-Mujahid Mohammad Faruque Osmany Johannes J. Rasker |
| author_facet | Muhammad Shoaib Momen Majumder Shamim Ahmed Tajkia Haque Syed Atiqul Haq Saumitra Chakravarty Md. Abu Shahin Din-E-Mujahid Mohammad Faruque Osmany Johannes J. Rasker |
| author_sort | Muhammad Shoaib Momen Majumder |
| collection | DOAJ |
| description | Background. Non-Hodgkin lymphomas (NHLs) comprise a group of haematologic malignancies with different histologic subtypes. The clinical picture varies from indolent to aggressive presentation and nodal (lymphadenopathy) to extranodal (central nervous system, gastrointestinal, cutaneous plaque, or ulcer) involvement. Digital gangrene is seldom reported. Here, we describe a patient with pain and blackening of all fingers and toes as presenting symptoms of NHL. Case Presentation. A 32-year-old male weaver had been smoking three to five cannabis-containing cigarettes daily for about ten years and methamphetamine four to five tablets daily for five years. He had no history of Raynaud’s phenomenon, fever, cough, weight loss, skin rash, joint pain, and atherogenic or thrombogenic risk factors. We found normal blood pressure and absent peripheral pulses in arms and legs, dry gangrene of all fingers and toes, generalized lymphadenopathy, and hepatomegaly with ascites. The chest X-ray was normal, as were blood sugar, lipid profile, and hepatic and renal function. Rheumatoid factor, antinuclear and antiphospholipid antibodies, C-ANCA and P-ANCA, hepatitis B and C, and HIV were negative. CT abdomen revealed hepatosplenomegaly with multiple intra-abdominal lymphadenopathies. The peripheral angiogram showed 90-99% stenosis of radial and dorsalis pedis arteries with normal proximal vessels. Diagnosis of non-Hodgkin lymphoma was confirmed by histopathology of cervical lymph node (diffuse type), immunohistochemically subtyped as peripheral T cell lymphoma (not otherwise specified). The digital ischemia worsened despite cessation of cannabis and methamphetamine and starting CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) treatment, making amputation necessary. Conclusion. We present, to our knowledge, the first report of peripheral T cell lymphoma, NOS presenting with gangrene in all digits complicated by methamphetamine and cannabis abuse. This uncommon vascular manifestation of non-Hodgkin lymphoma may cause a diagnostic dilemma and delayed initiation of treatment. |
| format | Article |
| id | doaj-art-42b38b2277f0455e96f2329170a25a44 |
| institution | Kabale University |
| issn | 2090-6994 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Vascular Medicine |
| spelling | doaj-art-42b38b2277f0455e96f2329170a25a442025-02-03T01:29:53ZengWileyCase Reports in Vascular Medicine2090-69942022-01-01202210.1155/2022/8963753Digital Gangrene: An Unusual Manifestation of Non-Hodgkin LymphomaMuhammad Shoaib Momen Majumder0Shamim Ahmed1Tajkia Haque2Syed Atiqul Haq3Saumitra Chakravarty4Md. Abu Shahin5Din-E-Mujahid Mohammad Faruque Osmany6Johannes J. Rasker7Department of RheumatologyDepartment of RheumatologyDepartment of RheumatologyDepartment of RheumatologyDepartment of PathologyDepartment of RheumatologyDepartment of CardiologyUniversity of TwenteBackground. Non-Hodgkin lymphomas (NHLs) comprise a group of haematologic malignancies with different histologic subtypes. The clinical picture varies from indolent to aggressive presentation and nodal (lymphadenopathy) to extranodal (central nervous system, gastrointestinal, cutaneous plaque, or ulcer) involvement. Digital gangrene is seldom reported. Here, we describe a patient with pain and blackening of all fingers and toes as presenting symptoms of NHL. Case Presentation. A 32-year-old male weaver had been smoking three to five cannabis-containing cigarettes daily for about ten years and methamphetamine four to five tablets daily for five years. He had no history of Raynaud’s phenomenon, fever, cough, weight loss, skin rash, joint pain, and atherogenic or thrombogenic risk factors. We found normal blood pressure and absent peripheral pulses in arms and legs, dry gangrene of all fingers and toes, generalized lymphadenopathy, and hepatomegaly with ascites. The chest X-ray was normal, as were blood sugar, lipid profile, and hepatic and renal function. Rheumatoid factor, antinuclear and antiphospholipid antibodies, C-ANCA and P-ANCA, hepatitis B and C, and HIV were negative. CT abdomen revealed hepatosplenomegaly with multiple intra-abdominal lymphadenopathies. The peripheral angiogram showed 90-99% stenosis of radial and dorsalis pedis arteries with normal proximal vessels. Diagnosis of non-Hodgkin lymphoma was confirmed by histopathology of cervical lymph node (diffuse type), immunohistochemically subtyped as peripheral T cell lymphoma (not otherwise specified). The digital ischemia worsened despite cessation of cannabis and methamphetamine and starting CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) treatment, making amputation necessary. Conclusion. We present, to our knowledge, the first report of peripheral T cell lymphoma, NOS presenting with gangrene in all digits complicated by methamphetamine and cannabis abuse. This uncommon vascular manifestation of non-Hodgkin lymphoma may cause a diagnostic dilemma and delayed initiation of treatment.http://dx.doi.org/10.1155/2022/8963753 |
| spellingShingle | Muhammad Shoaib Momen Majumder Shamim Ahmed Tajkia Haque Syed Atiqul Haq Saumitra Chakravarty Md. Abu Shahin Din-E-Mujahid Mohammad Faruque Osmany Johannes J. Rasker Digital Gangrene: An Unusual Manifestation of Non-Hodgkin Lymphoma Case Reports in Vascular Medicine |
| title | Digital Gangrene: An Unusual Manifestation of Non-Hodgkin Lymphoma |
| title_full | Digital Gangrene: An Unusual Manifestation of Non-Hodgkin Lymphoma |
| title_fullStr | Digital Gangrene: An Unusual Manifestation of Non-Hodgkin Lymphoma |
| title_full_unstemmed | Digital Gangrene: An Unusual Manifestation of Non-Hodgkin Lymphoma |
| title_short | Digital Gangrene: An Unusual Manifestation of Non-Hodgkin Lymphoma |
| title_sort | digital gangrene an unusual manifestation of non hodgkin lymphoma |
| url | http://dx.doi.org/10.1155/2022/8963753 |
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