title: Hodgkin lymphoma presenting with various immunologic abnormalities, including autoimmune hepatitis, Hashimoto's thyroiditis, autoimmune hemolytic anemia, and immune thrombocytopenia.
abstract: 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.
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: Yasuyuki
authors.initials: Y
authors.lastname: Saito
authors.forename: Arito
authors.initials: A
authors.lastname: Yamane
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yokohoma
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Irisawa
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: Masaru
authors.initials: M
authors.lastname: Kojima
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nojima
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Murakami
mesh_terms: 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*