Banu GÜLBAY, Cabir YÜKSEL, Şeyda Nur Çövüt

KOAH ve Non-Hodgkin Lenfomalı bir olguda yeni başlangıçlı nefes darlığı; Non-Hodgkin Lenfoma ile ilişkili pulmoner komplikasyonlar nedeniyle

Non-Hodgkin lenfoma (NHL) lenf nodları ya da ekstranodal lenfatik dokudanköken alan B veya T hücre progenitörlerinin klonal proliferatif hastalığıdır.NHL ile ilişkili çeşitli pulmoner komplikasyonlar bulunmaktadır. Kronikobstrüktif akciğer hastalığı (KOAH) ve NHL tanılarıyla takip edilen hastamızdagelişen lenfomaya ait mortalite ve morbiditesi yüksek olan iki pulmonerkomplikasyonu tartışmak ve önemini vurgulama istedik. Yetmiş bir yaşındaerkek hasta acil servise ani başlayan nefes darlığı ve göğüs ağrısı yakınmalarıylabaşvurdu. Hastada 18 yıldır KOAH nedeniyle bronkodilatör kullanımı ve 8 yılönce de NHL nedeniyle kemoterapi ve lokal radyoterapi alma öyküsümevcuttu. Pulmoner tromboemboli (PTE) açısından klinik olarak düşük-ortariskli grup olarak değerlendirilmiştir. Pulmoner bilgisayarlı tomografi (BT)anjiyografi çekilerek PTE tanısı konmuştur. Düşük molekül ağırlıklı heparin(DMAH) tedavisi altında artan nefes darlığı nedeniyle başvurduğu acilserviste çekilen akciğer grafisinde tek taraflı submasif plevral sıvı saptanmıştır.Torasentezle örneklenen plevra sıvısında trigliserid düzeyi > 110 mg/dLizlenerek şilotoraks tanısı konmuştur. Pleuroken takılıp diyeti düzenlenen venüks NHL nedeniyle tek kür kemoterapi verilen hastanın genel durumundakötüleşme izlenmiş ve hasta kaybedilmiştir. Hematolojik onkolojilerdetromboz insidansı %2 ila %58 arasında değişmektedir. PTE hematolojikonkolojilerde ani başlayan nefes darlığı durumunda mutlaka düşünülmesigereken bir komplikasyondur. Etkin PTE tedavisi altında artan nefes darlığıikincil bir olay olarak değerlendirilmiş ve özellikle lenfomada bir diğerpulmoner komplikasyon olan şilotoraks saptanmıştır. Lenfoma tanılı hastamız,lenfoma ile ilişkili pulmoner komplikasyonları nedeniyle sunulmuştur

The pulmonary complications related lymphoma in the patient with COPD and Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (NHL) is a clonal proliferative disease of B or T cell progenitors originating from lymph nodes or extranodal lymphatic tissue. There are several pulmonary complications associated with NHL. We aimed to discuss two pulmonary complications with high morbidity and mortality associated with lymphoma in our patient followed up with COPD and NHL. Seventy one years old male patient was admitted to the emergency department with sudden onset of dyspnea and chest pain. He had a history of bronchodilator use for COPD for 18 years and chemotherapy and local radiotherapy because of NHL 8 years ago. In terms of pulmonary thromboembolism (PTE), it was evaluated as clinically low-medium risk group. Pulmonary CT angiography was performed to diagnose PTE. Unilateral subcutaneous pleural fluid was detected in the chest radiography performed in the emergency room where he was admitted to the hospital due to increased dyspnea under low molecular weight heparin (LMWH) treatment. Triglyceride level > 110 mg/dL was observed in pleural fluid sampled by thoracentesis and diagnosed as chylothorax. He was followed by a pleuroken stool diet and received only one course of chemotherapy because of relapse NHL. Her general condition deteriorated and the patient died. The incidence of thrombosis in hematological oncology varies between 2% and 58%. PTE is a complication that must be considered in case of sudden onset of shortness of breath in hematologic oncologies. Increased shortness of breath under effective PTE treatment was considered as a secondary event and chylothorax, another pulmonary complication, was detected especially in lymphoma. Our patient with lymphoma was presented because of pulmonary complications associated with lymphoma.

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