Here’s how readers responded to a You Make the Call question about management options for a patient with recurrence of lymphomatoid granulomatosis.
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It is important to look for an association between the lymphomatoid granulomatosis and viral infection, particularly HIV and Epstein-Barr virus (EBV). Also, if the pulmonary lesions are isolated, opt for surgical resection and chemotherapy.
Management will differ depending on the grade of the lymphomatoid granulomatosis. If it is low grade, I would treat the patient with chemoimmunotherapy or a combination of interferon alfa and intravenous gamma immunoglobulin. If it is high grade, I would treat with dose-adjusted EPOCH-R or a similar therapy.
Shanika Vitharana, MBBS, MD
Colombo, Sri Lanka
I would look at the grade of the lymphomatoid granulomatosis first. If it is still grade 3, I would treat the patient with salvage chemotherapy with consideration for an autologous hematopoietic cell transplantation. If it is grade 1 or 2 and the patient remains asymptomatic, I would continue observation until she recovers from the recurrent strokes and varicella zoster virus infection and then start treatment when she becomes more symptomatic.
Lee Bee Sun, MBBS
Kajang, Malaysia
