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Can folate replacement induce lymphoma progression?
  1. Nobuhiro Ariyoshi1,
  2. Eiji Hiraoka1,
  3. Ryosuke Koyamada2
  1. 1Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
  2. 2Hematology, St. Lukes Hospital, Chuo-ku, Tokyo, Japan
  1. Correspondence to Dr Eiji Hiraoka, eijih{at}


A 43-year-old Japanese man with a low haemoglobin level of 1.3 g/dL and multiorgan dysfunction syndrome (MODS) was admitted to our hospital. He was diagnosed with folate deficiency, which was initially attributed to his malnutrition. He was transfused with several units of packed red blood cells and treated with folate, thiamine and vitamin B12 supplements; he showed a prompt haematological response and recovery from MODS. However, 3 weeks after the initial recovery, he had a relapse of pancytopenia and developed high-grade fever along with rapidly enlarging, generalised lymphadenopathy. Bone marrow biopsy revealed hemophagocytosis, and lymph node biopsy revealed peripheral T-cell lymphoma, not otherwise specified. Folate supplementation may have promoted lymphoma progression.

  • malnutrition
  • vitamins and supplements

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  • Contributors NA, EH and RK contributed to case management, discussion of the case and manuscript writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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