Yoshihiro Amemiya

Postoperative death of a patient in apparent remission of malignant lymphoma after dissection for squamous cell carcinoma

A 67-year-old man in apparent remission of malignant lymphoma had squamous cell carcinoma of the left buccal mucosa. The patient underwent partial resection of the mandible, including the excision of the tumor. During the fourth postoperative night the patient suddenly became febrile and had a spiking fever for the next 5 days. His general condition deteriorated afterward, and acute aggravation of malignant lymphoma was suspected. On day 16 disseminated intravascular coagulation was indicated by a decreased platelet count of 3.8 x 10(4), a tendency toward bleeding, and multiple organ failure. The patient died 18 days postoperatively. We alert anesthesiologists and surgeons that surgically treating patients with malignant lymphoma who are receiving immunosuppressive drugs is precarious even though their disease is considered to be in apparent remission.