title: Hodgkin lymphoma accompanied by aplastic anemia and polyclonal expansion of large granular lymphocytes.
abstract: Immunologic abnormalities have been described in patients with Hodgkin lymphoma, including autoimmune hemolytic anemia and immune thrombocytopenic purpura. The concurrent diagnoses of Hodgkin lymphoma and acquired aplastic anemia, however, is extremely rare. We report a 56-year-old Japanese female patient with severe aplastic anemia and increased large granular lymphocytes prior to the recurrence of Hodgkin lymphoma. After being in remission for 10 years from Hodgkin lymphoma, she developed progressive pancytopenia. The large granular lymphocytes (expressed CD3+ CD8+ TCRalphabeta+) had a polyclonal distribution, the serum-soluble FasL concentration was significantly elevated, and bone marrow biopsy showed severely hypocellular bone marrow without infiltration of abnormal lymphocytes. No lymphadenopathy was observed that would suggest a relapse of Hodgkin lymphoma. A diagnosis of aplastic anemia was made, and treatment with corticosteroids and cyclosporine was initiated. Two months later, she suddenly developed celiac and mediastinal lymphadenopathy. She underwent one cycle of chemotherapy before she died of progressive pancytopenia. Autopsy revealed the recurrence of Hodgkin lymphoma, nodular sclerosis in the lymph nodes and markedly hypocellular bone marrow. Although autoimmune disorders are described in Hodgkin lymphoma, our case shows a rare instance of a patient who had aplastic anemia as the first manifestation of a relapse of Hodgkin lymphoma.
authors.affiliation: Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Gunma, Japan. tsaitoh@showa.gunma-u.ac.jp
authors.forename: Takayuki
authors.initials: T
authors.lastname: Saitoh
authors.forename: Takafumi
authors.initials: T
authors.lastname: Matsushima
authors.forename: Arito
authors.initials: A
authors.lastname: Yamane
authors.forename: Masataka
authors.initials: M
authors.lastname: Sakuraya
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Irisawa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yokohama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Handa
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsukamoto
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Karasawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nojima
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Murakami
mesh_terms: D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications* / Q000473:pathology / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001803:Blood Transfusion; D005260:Female; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008214:Lymphocytes / Q000166:cytology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged