A 60-year-old male, with the only antecedents of hiatal hernia and irritable colon, was admitted to our service due to continuous pain in the left lumbar region, irradiated to the abdomen, which improved with ibuprofen and walking.
The pain was accompanied by progressive general deterioration, without hypoxia, weight loss or other symptoms.
Physical examination was normal.
The blood count and biochemical profile of blood and urine were normal, with SGA 16 /30 mm. The plain abdominal X-ray was also normal, while CAT scan showed numerous lymph nodes by retroperitoneal size.
An increase in density of adjacent fat mass was also observed.
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These findings were discussed with the General Surgery Service, performing an exploratory laparotomy with biopsies, which showed the following result: with significant crystals in mesentery fat and cholesterol ratio, granuloma.
Some of these foamy histiocytes were available affecting vessels, small arterioles with perivascular infiltrate of lymphocytes.
No deposits of PAS-positive material were observed inside histiocytes, nor bacilli acid-fast resistant, nor authenticated Whipple's disease was ruled out.
A combined treatment with corticosteroids was initiated. A monthly bolus of cyclophosphamide (control) and cyclophosphamide (m) was administered. The patient showed clinical improvement in the number of lymph nodes, as well as progressive reduction in the size of the TAC.
Treatment was continued with monthly bolus until the sixth month and then with bimonthly bolus.
In the last CT scan performed 9 months after starting treatment, lesions continue to decrease months later this progressive improvement is maintained.
