title: Unusual cause of cholestatic jaundice in a patient with AIDS.
abstract: A 61-year-old man with AIDS on chronic highly active antiretroviral treatment (HAART) presented with lethargy and jaundice and was found to have abnormal liver function tests (LFTs). Investigations including viral/autoimmune markers and imaging were unrevealing, except for positive Epstein-Barr virus. HAART was held, however, transaminases and total bilirubin continued to rise. The liver biopsy revealed classical Hodgkin's lymphoma (HL). HL presenting only with liver findings without lymphadenopathy is rare. Extreme cases can lead to fulminant liver failure. The bone marrow biopsy and dramatic elevation in serum ferritin were consistent with haemophagocytic lymphohistiocytosis. Finding a chemotherapy regimen was challenging given abnormal LFTs and HAART interactions. Initial chemotherapy regimen has successfully decreased LFTs; however, it was limited by pancytopenia. The patient's regimen was changed, however second regimen was complicated by neuropathy. LFTs improved and the patient was able to receive the standard care chemotherapy for HL with significant clinical, laboratory and radiological improvement.
authors: Department of Medicine, Jacobi Medical Center, Bronx, New York, USA. subin1004@gmail.com
authors: Su Bin
authors: SB
authors: Kim
authors: Makardhwaj Sarvadaman
authors: MS
authors: Shrivastava
authors: Jesus M
authors: JM
authors: Anampa
authors: Marianna
authors: M
authors: Strakhan
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000410:Alanine Transaminase / Q000097:blood; D023241:Antiretroviral Therapy, Highly Active; D001219:Aspartate Aminotransferases / Q000097:blood; D006689:Hodgkin Disease / Q000150:complications*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology*; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
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