日赤 No.35☆/7.河相

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1 Mucosa-Associated Lymphoid TissueMALT T γ- 1 Key words T MALT 63 T MALT T MALT 63 CHOP μg 200 mg 20 mg 200 mg 400 mg/80 mg

2 2 35 mg mg 200 mg mg ,000/μL sil 2-R706 μ /ml1,070 μ / mligg1,824 mg/dl 2,192 mg/dl CRP 1.0 mg/dl mg mg/ /60 mmhg WBC RBC HGB PLT IgG IgA IgM /μl /μl 12.0 g/dl /μl 1824 mg/dl mg/dl 141 mg/dl CRP LDH ALP T Bil TP ALB BUN CRE Na K Cl sil2 R 0.59 mg/dl 376 U/L 411 U/L 1.1 mg/dl 8.2 g/dl 3.66 g/dl 30.9 mg/dl 1.00 mg/dl 136 MEQ/ 4.9 MEQ/ 101 MEQ/ 706 U/mL 1070 a b 1a,b 20

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5 Vol a b 6a,b 107 a b c 7a,b,c 114 abc

6 mg mg mg mg/kg mg/kg 60 mg/kg 5 10 mg/kg mg mg 1000 mg HIV SLE 1 T

7 Vol , γ 5 6, HIV MB Derma 2008 ; 147 : Imafuku S, Yoshimura D, Moroi Y, et al. Systemic varicella zoster virus reinfection in a case of angioimmunoblastic T-cell lymphoma. J Dermatol 2007 ; 34 : T 2005 ; 212 : ; 65 : ; 99 : Kanda Y, Mineishi S, Saito T, et al. Long-term lowdose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2001 ; 28 : Asano-Mori Y, Kand Y, Oshima K, et al. Long-term ultra-low-dose acyclovir against varicella-zoster virus reactivation after allogeneic stem cell transplantation. Am J Hematol 2008 ; 83 : ; 50 :

8 2 A case report of refractory generalized herpes zoster in which the patient developed two different malignant lymphomas Department of Dermatology, Japanese Red Cross Kyoto Daini Hospital Minako Kawai, Junko Daito, Fujiko Soga, Yasuko Yamada, Yoshihiro Ikeda Department of Hematology, Japanese Red Cross Kyoto Daini Hospital Teruaki Akaogi Abstract A 64-year-old female developed two different malignant lymphomas. At 60 years of age, she developed MALT lymphoma of the gastroduodenal bulb and was treated with rituximab and fludarabine, achieving partial remission. At 63 years of age, she subsequently developed angioimmunoblastic T-cell lymphoma characterized by severe immunodeficiency and was treated with CHOP and etoposide. These drugs were ultimately discontinued, and therapy with cyclosporineprednisolone was started. Twenty-eight weeks later, the patient was diagnosed with herpes zoster of the right trunk, which resolved following treatment with oral valacyclovir and famciclovir. After adding a low dose of etoposide in order to intensify the antitumor efficacy, the herpes zoster relapsed significantly. Although etoposide was discontinued and acyclovir, gamma globulin and vidarabine were administered intravenously, the herpes zoster did not improve, but rather became generalized. The dose of cyclosporine was then gradually decreased with the goal of reducing the immunosuppression in parallel with the administration of antiherpesvirus therapy. Following the completion of the intravenous antiherpesvirus therapy, the oral antiherpesvirus agents (primarily famciclovir)were restarted, and the generalized vesicles became crusted. Immediately after increasing the dose of cyclosporine and decreasing the dose of famciclovir, the herpes zoster recurred. Therefore, the lymphoma was treated with low-dose cyclosporine, and the preventive internal administration of famciclovir was continued for more than one year. Key words : generalized herpes zoster, angioimmunoblastic T-cell lymphoma, famciclovir, preventive internal administration

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