Thrombocytopenia as the Initial Presentation
of Angioimmunioblastic T-Cell Lymphoma (AITL)
Maria Batool, MD; Biana Leybishkis, MD; Nihad Yasmin, MD
Aurora Health Care Internal Medicine Residency – Milwaukee, WI
Case Presentation:
Further Workup:
• 85 year old female presented with a one week history of
• Bone marrow biopsy:
generalized weakness and knee pain.
• PMH: HTN, GERD, osteoarthritis.
• SH: No history of alcohol, tobacco or illicit drug use.
• Review of symptoms was negative except for dry cough.
Physical Examination:
– Moderate normocytic anemia, severe thrombocytopenia
and mild immature myeloid shift
• Serum electrophoresis:
– Polyclonal elevation of gamma globulins without
monoclonal protein
Discussion:
•A
ITL is a type of peripheral T-cell non-Hodgkin lymphoma.
•M
ost commonly presents with systemic B symptoms, generalized
lymphadenopathy, hepatosplenomegaly, polyarthritis and anemia.
•9
1% of patients with AITL have involvement of at least 2 or more lymph
node groups palpable on physical exam which was absent in our patient.
•7
% of patients have idiopathic thrombocytopenic purpura which is a
• Right axillary lymph node biopsy:
consequence of the immune dysregulation that is part of the spectrum
of AITL.
– Pathology diagnostic for Angioimmunoblastic T-cell Lymphoma
• Bone marrow is infiltrated in 60% of the patients.
•V
ital signs: BP: 112/52, Pulse: 91/min, RR:16, Temp: 99,
•S
tudies looking specifically at patients with uninvolved bone marrow
Pulse Ox: 100% on room air.
found only one of six cases to have platelet count below 150,000 x 109
which was actually the only significant initial finding in our patient.
• HEENT: mild conjunctival pallor.
• Musculoskeletal: 1+ pitting edema bilateral lower extremities.
• Lymphatics: No peripheral lymphadenopathy.
Conclusion:
•A
ITL presents a diagnostic challenge for physicians because of its
Laboratory Data:
nonspecific hematologic and immunologic manifestations.
• Hemoglobin: 9.2 g/dl
• Platelets: 10,000 x 109/L
• HCT: 29.2%
• INR: 1.5
• MCV: 82fl
• Adams 13: Negative
• Peripheral smear: Schistocytes
• LDH: 412 U/L
•A
ITL must be kept in mind in the setting of unexplained
thrombocytopenia even if the typical features of a lymphoma are absent.
CISH staining for EBV positive cells.
• Absolute reticulocyte count: 51 x 109/L
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