Bilateral adrenal infarction during brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisolone therapy for ALK-negative anaplastic large cell lymphoma: A case report.

Most bilateral adrenal incidentalomas are neoplastic lesions, and adrenal infarction is a rare cause. In this report, a case of bilateral adrenal infarction in a patient with ALK-negative anaplastic large cell lymphoma is presented, which, to our knowledge, has not been previously reported. A 63-year-old man on day 6 of brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisolone therapy for ALK-negative anaplastic large cell lymphoma presented with vomiting and pain in the left side of the abdomen and epigastric region. Acute pancreatitis was suspected, and contrast-enhanced computed tomography was performed, revealing bilateral adrenal partial non-enhancement of both adrenal glands. On T2-weighted non-contrast magnetic resonance imaging, moderate hyperintensity was observed in both adrenal glands, along with hyperintensity in the periadrenal region. Based on these findings, a diagnosis of bilateral adrenal infarction was made. No adrenal insufficiency was detected. The patient's symptoms improved after anticoagulant therapy was initiated. Approximately 13 months later, contrast-enhanced computed tomography showed a reduction in the size of both adrenal glands and good contrast enhancement, indicating resolution of the infarction. This case highlights that ALK-negative anaplastic large cell lymphoma and its treatments can cause thrombosis, potentially leading to adrenal infarction. Adrenal infarction should be considered in patients undergoing treatment for hematologic malignancies who present with abdominal symptoms and unexplained adrenal enlargement or enhancement defects on contrast-enhanced computed tomography.