. 2021; 49(5): 414-418 | DOI: 10.5543/tkda.2021.57474 | |||
Sağ atriyum tutulumu yapan diffüz büyük B-hücreli lenfomanın tam remisyonu sırasında çok gecikmiş sinüs arrestiToshimitsu Tsugu1, Yuji Nagatomo2, Emiko Matsuyama3, Patrizio Lancellotti1, Hideo Mitamura31Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium2Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan 3Department of Cardiology, Federation of National Public Service Personnel Mutual Aid Association Tachikawa, Hospital, Tachikawa, Japan Diffüz büyük B hücreli lenfoma (DLBCL) ile ilişkili aritmiler, kardiyak tutuluma veya kemoterapiye bağlı olabilir. DLBCL’nin tam remisyonu sırasında normal kardiyak fonksiyona sahip hastalarda meydana gelen önemli aritmiler bildirilmemiştir. Yıllık sağlık kontrollerinde anormal elektrokardiyogram (EKG) öyküsü olmayan 57 yaşında kadın hasta düşük nabız, ateş, gece terlemeleri ve kilo kaybı nedeniyle hastanemize başvurdu. Başvuru sırasında EKG, sinüs atımları ve ara sıra kaçış atımlarından oluşan değişken bir ritim gösterdi. Bilgisayarlı tomografi ve 18F-florodeoksiglukoz pozitron emisyon tomografisi (FDG-PET/BT) sağ atriyum (RA) ve uterusta iki kitle ortaya çıkardı. Total histerektomi yapıldı ve patolojik bulgular diffüz büyük B hücreli lenfoma (DLBCL) ile uyumluydu. Kemoterapi (R-CHOP) başlandı. İki kemoterapi küründen sonra, RA tümörleri kayboldu ve bradiaritmi, antiaritmik ilaç tedavisi olmaksızın aynı anda sinüs ritmine dönüştü. Kemoterapinin tamamlanmasından altı ay sonra, FDG-PET/CT RA ve uterusta tutulum saptanmadığını ortaya koydu. DLBCL’de tam remisyon sağlandı, ancak EKG’de sinüs arresti nedeniyle bradikardi görüldü. Olgumuz, DLBCL’ye bağlı aritminin remisyondan sonra bile ortaya çıkabileceğini ve izlenmesi gerektiğini düşündürmektedir. Very delayed sinus arrest during complete remission of diffuse large B-cell lymphoma invading right atriumToshimitsu Tsugu1, Yuji Nagatomo2, Emiko Matsuyama3, Patrizio Lancellotti1, Hideo Mitamura31Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium2Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan 3Department of Cardiology, Federation of National Public Service Personnel Mutual Aid Association Tachikawa, Hospital, Tachikawa, Japan Diffuse large B-cell lymphoma (DLBCL)-associated arrhythmias may be due to cardiac involvement or may be chemotherapy-induced. There have been no reports of significant arrhythmias with normal cardiac function occurring during the complete remission of DLBCL. A 57-year-old female, who had had no history of abnormal electrocardiograms (ECGs) in annual medical checkups, was admitted to our hospital because of low-grade fever, night sweats, and weight loss. On admission, ECG revealed a variable rhythm consisting of sinus beats and occasional escape beats. Computed tomography and 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) revealed two masses in the right atrium (RA) and the uterus. Total hysterectomy was performed, and pathological findings were consistent with diffuse large B-cell lymphoma (DLBCL). Chemotherapy (R-CHOP) was initiated. After two chemotherapy cycles, RA tumors disappeared, and bradyarrhythmia simultaneously converted to sinus rhythm without antiarrhythmic drug therapy. Six months after completion of chemotherapy, FDG-PET/CT revealed negative uptake in the RA and the uterus. The patient attained complete remission of DLBCL, but ECG showed bradycardia because of sinus arrest. Our case suggests that DLBCL-induced arrhythmia can occur even after its remission and should be monitored. Keywords: Doxorubicin, Cardiotoxicity, Cardiac tumor, ArrhythmiaToshimitsu Tsugu, Yuji Nagatomo, Emiko Matsuyama, Patrizio Lancellotti, Hideo Mitamura. Very delayed sinus arrest during complete remission of diffuse large B-cell lymphoma invading right atrium. . 2021; 49(5): 414-418 Sorumlu Yazar: Toshimitsu Tsugu, Belgium |
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