Hodgkin lymphoma presenting with various immunologic abnormalities, including autoimmune hepatitis, Hashimoto's thyroiditis, autoimmune hemolytic anemia, and immune thrombocytopenia.
Immunologic abnormalities have been described in patients with Hodgkin lymphoma, including autoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP). In this report, we describe a rare case of a 59-year-old woman who had autoimmune-mediated hepatitis and Hashimoto's thyroiditis at initial presentation of Hodgkin lymphoma. She was treated with ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine), which induced a complete remission. One year later, she developed a sudden Coombs-positive hemolytic anemia and immune thrombocytopenia. She was diagnosed with Evans syndrome and was treated with prednisolone and intravenous immunoglobulin. However, the response of the therapies was poor; she died of progressive thrombocytopenia. The autopsy revealed the relapse of Hodgkin lymphoma of cervical lymph nodes. Although autoimmune disorders are described in Hodgkin lymphoma, our case shows a rare instance of a patient who had various immunologic abnormalities, including autoimmune-mediated hepatitis, Hashimoto's thyroiditis, AIHA, and ITP.
Saitoh
Takayuki
T
Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Gunma, Japan. tsaitoh@showa.gunma-u.ac.jp
Matsushima
Takafumi
T
Saito
Yasuyuki
Y
Yamane
Arito
A
Yokohoma
Akihiko
A
Irisawa
Hiroyuki
H
Handa
Hiroshi
H
Tsukamoto
Norifumi
N
Karasawa
Masamitsu
M
Kojima
Masaru
M
Nojima
Yoshihisa
Y
Murakami
Hirokazu
H
D000744:Anemia, Hemolytic, Autoimmune / Q000209:etiology*; D005260:Female; D050031:Hashimoto Disease / Q000209:etiology*; D019693:Hepatitis, Autoimmune / Q000209:etiology*; D006689:Hodgkin Disease / Q000150:complications* / Q000276:immunology; D006801:Humans; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000209:etiology*