A 39-year-old mestizo girl was admitted to our hospital for the first time in February 1999.
Ten years ago he had begun to present pain in his knees and ankles, without apparent inflammatory signs, which relieved with Indomethacin and was also accompanied by asthenia.
In his province of origin he had been admitted several times without reaching an etiologic diagnosis.
This joint condition evolved in the form of episodes, accompanied by fever and proven anemia.
Physical examination revealed only slight mucosal penetration, increased ankles, adenopathy of 1 cm, mobile and elastic in the right inguinal region.
The laboratory tests in the first stage were as follows: hemoglobin 98 g/l, hematocrit 30 vol%, normal leukocyte count and platelets, reticulocytes, glycemia, creatinine, AST and ALT all within normal limits PT, restPT.
Protein electrophoresis showed hypergammaglobulinemia 32.85 g/l, erythrocyte sedimentation rate 115 mm/h and 106 at the second opportunity.
Ultrasound of the upper hemiabdomen showed no alteration.
The patient was discharged without an accurate diagnosis.
She was readmitted in January 2004 for asthenia and fever of 38 to 39 oC on a regular basis for one week with spontaneous remission intervals every two or three months.
She had joint pains in her knees and ankles that improved with nonsteroidal anti-inflammatory drugs.
Physical examination showed an adenopathy in the right supraclavicular region of about 2 cm, of elastic consistency and fixed to deep planes.
Laboratory tests: hemoglobin 110 g/l, erythrocyte sedimentation rate 130 mm/h, polyclonal hypergammaglobulinemia of 36 g/l; medullogram: reactive medulla with increased erythrocytes.
Abdominal ultrasound: mild diffuse hepatomegaly with increased ecorrefringence; chest plaque: widening of the right upper contour of the mediastinum; Mediastinal CAT: adenomegaly in the right upper mediastinum fields, 3 cm
Cervical lymph node biopsy: partial loss of architecture with marked focal lymphoid hyperplasia and expansion of the interfollicular area occupied by abundant folliculocytes and bodies.
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Immunohistochemistry: CD20 positive in T lymphoid cells, kappa and lambda positive in lymphocytes.
Conclusions: ECC cellular type.
The treatment consisted of polychemotherapy with adriamycin, vincristine, bleomycin and prednisone and was discharged for outpatient follow-up.
