A 70-year-old Japanese woman with a 57-year history of hepa- titis C virus presented with nausea, abdominal pain, and renal dysfunction. Physical examination revealed splenome- galy. Blood examination revealed elevated levels of C reactive protein (2.7 mg/dL), serum creatinine (2.46 mg/dL), blood urea nitrogen (22 mg/dL), and uric acid (7.8 mg/dL). Test for myeloperoxidase-antineutrophil cytoplasmic antibody (MPO- ANCA) was positive (71.2 U/mL). Urinalysis showed proteinuria (0.56 g/gCr) and microhematuria (>100 red blood cells/high- power field). 18 F-fluorodeoxyglucose-positron emission tomo- graphy/computed tomography (FDG-PET-CT) revealed FDG accumulation in the cervical, thoracic, and abdominal lymph nodes and spleen (Fig. 1A). Abdominal computed tomo graphy revealed splenomegaly with a low-density area (Fig. 1B). Renal biopsy specimen showed crescentic glome- rulonephritis (Fig. 1C). Abdominal paraaortic lymph node biopsy revealed diffuse large B cell lymphoma (DLBCL). Based on these findings, the patient was diagnosed with ANCA-associated vasculitis (AAV) and DLBCL with suspec- ted splenic DLBCL. Treatment with R-CHOP regimen was initiated, and her renal function improved. However, no remission was noted for the DLBCL. The patient died 4 months later.
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