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Old‐aged case of indolent grade III lymphomatoid granulomatosis successfully treated only with oral prednisolone

Dear Editor, Lymphomatoid granulomatosis (LYG) is an angiocentric and angiodestructive lymphoproliferative disorder characterized by prominent pulmonary involvement. The skin and nervous systems are also involved. Although LYG occasionally progresses to malignant lymphoma, it is still considered a type of benign lymphoma or an inflammatory disorder. We report an oldaged LYG patient successfully treated with low-dose prednisolone monotherapy. A 93-year-old Japanese man with general fatigue and dry cough presented with a 12-year history of generalized nodular skin lesions, which had gradually increased in size and number. When the lesions started, the patient also visited us with arthralgia, and dermatomyositis had been suspected. Clinical examination revealed asymptomatic violaceous to red-colored dome-shaped nodules and subcutaneous nodules, scattered on the trunk and extremities (Fig. 1a). Laboratory tests revealed slight decrease of lymphocytes (23.2% in 6600/lL leukocytes), and elevations of lactose dehydrogenase at 256 IU/L and soluble interleukin-2 receptor at 1240 IU/mL (normal, 145–519 IU/mL). Antibodies to human T-lymphotropic virus 1 and HIV were negative. The patient had already been immunized against Epstein–Barr virus (EBV) (EBV anti-VCA-immunoglobulin [Ig]M <10; EBV anti-VCA-IgG, 9320; anti-EBNA IgG antibody, 920) and EBV DNA (real-time polymerase chain reaction) was present at 3.5 9 10 copies. (a) (b)