@entity12692 and XXXX , a rare association resulting in a "mixed" response: a case report.

@entity1 @entity650 @entity1071 @entity353 @entity738 @entity5 @entity2318 @entity12692 @entity381 @entity12321 @entity370 @entity221
INTRODUCTION: @entity12321 is a rare @entity1071 whose hallmark is atypical @entity12692 . Symptoms can include @entity221 , @entity381 , and abnormal blood cell counts. High levels of @entity650 ( @entity650 ) are observed frequently in this disorder and are believed to drive the disease. Recently, therapies that target @entity650 or its receptor have been shown to be effective in @entity12692 . CASE PRESENTATION: We report the case of a 76-year-old Caucasian @entity1 with aggressive biopsy-proven @entity12692 who experienced pulmonary and lymph node involvement, as well as @entity221 and @entity353 . He was treated with siltuximab, a chimeric anti- @entity650 antibody. After 5 months, fluorodeoxyglucose positron emission tomography computed tomography scans showed marked improvement in his lungs, but worsening mediastinal disease, consistent with a mixed response. Biopsy of the mediastinal disease revealed lymphoplasmacytic infiltrate with non-caseating, ill-defined @entity738 and @entity2318 consistent with @entity370 . Prednisone 50mg by mouth daily was started, which was tapered to 2.0-5.0mg daily. Siltuximab was continued. A subsequent fluorodeoxyglucose positron emission tomography computed tomography scan showed near-complete resolution of lung and mediastinal disease, now ongoing for 3.5+ years without serious adverse events. CONCLUSIONS: Lymphomas have previously been reported to coexist with @entity370 , albeit rarely, but there has been only a single previous case of this type with @entity12692 . Of importance, early recognition of the presence of @entity370 in our @entity1 prevented discontinuation of siltuximab therapy due to "progression." Our experience may also have broader implications in that it suggests that etiology of "mixed responses" should be confirmed by performing biopsies on the progressive @entity5 .
