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Cardiology

Multiple Systemic Lesions in a Middle-aged Woman With a History of Lymphoma

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Cardiology

Published Online: September 22, 2021

JAMA Cardiology Clinical Challenge

Article Information and Disclosures

Deacon Z. J. Lee, MBChB, CCDS¹;

Elsie T. Nguyen, MD¹;

Harry Rakowski, MD²

Author Affiliations

¹Joint Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
²Division of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada

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A woman in her mid-60s, who was in remission following successful combination chemotherapy for Burkitt lymphoma 8 years previously, presented with dyspnea, fatigue, general malaise, and presyncope. On examination, she was normotensive, afebrile, and clinically euvolemic. Laboratory testing showed a hemoglobin level of 12.1 g/dL (to convert to grams per liter, multiply by 10), white blood cell count of 9900/µL (to convert to ×10⁹ per liter, multiply by 0.001), erythrocyte sedimentation rate of 76 mm/h, lactate dehydrogenase level of 139 U/L (to convert to microkatals per liter, multiply by 0.0167), and normal coagulation profile. Serum immunoglobulin quantitation showed normal immunoglobulin (Ig) G, IgA, and IgM levels of 1590 mg/L, 303 mg/L, and 94 mg/L, respectively (to convert to grams per liter, multiply by 0.01). Blood culture findings were negative.

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A woman in her mid-60s, who was in remission following successful combination chemotherapy for Burkitt lymphoma 8 years previously, presented with dyspnea, fatigue, general malaise, and presyncope. On examination, she was normotensive, afebrile, and clinically euvolemic. Laboratory testing showed a hemoglobin level of 12.1 g/dL (to convert to grams per liter, multiply by 10), white blood cell count of 9900/µL (to convert to ×10⁹ per liter, multiply by 0.001), erythrocyte sedimentation rate of 76 mm/h, lactate dehydrogenase level of 139 U/L (to convert to microkatals per liter, multiply by 0.0167), and normal coagulation profile. Serum immunoglobulin quantitation showed normal immunoglobulin (Ig) G, IgA, and IgM levels of 1590 mg/L, 303 mg/L, and 94 mg/L, respectively (to convert to grams per liter, multiply by 0.01). Blood culture findings were negative.

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Article Information

Corresponding Author: Harry Rakowski, MD, Division of Cardiology, Toronto General Hospital, 585 University Ave, Toronto, ON M5G 2N2, Canada (dr.harry.rakowski@uhn.ca).

Published Online: September 22, 2021. doi:10.1001/jamacardio.2021.3566

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

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Khosroshahi A , Carruthers MN , Deshpande V , Unizony S , Bloch DB , Stone JH . Rituximab for the treatment of IgG4-related disease. Medicine (Baltimore). 2012;91(1):57-66. doi:10.1097/MD.0b013e3182431ef6 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.