Febrile cholestatic disease as an initial presentation of nodular lymphocyte-predominant Hodgkin lymphoma

Abstract

Febrile cholestatic liver disease is an extremely unusual presentation of Hodgkin lymphoma (HL). The liver biopsy of a 40-year-old man with febrile episodes and cholestatic laboratory pattern disclosed an uncommon subtype of HL, a nodular lymphocyte-predominant HL (NLPHL). Liver involvement in the early stage of the usually indolent NLPHL's clinical course suggests an aggressiveness and unfavorable outcome. Emphasizing a liver biopsy early in the diagnostic algorithm enables accurate diagnosis and appropriate treatment. Although rare, HL should be considered in the differential diagnosis of cholestasis.

Fulminant Hepatic Failure as the Initial Presentation of Hodgkin Lymphoma in 4 Patients With Human Immunodeficiency Virus

“…HL can cause hepatic dysfunction through a number of pathways. Infiltration of the hepatic parenchyma by HL cells leads to necrosis and infiltration of the hepatic bile ducts, which causes obstruction and cholestasis [ 12 , 13 ]. Paraneoplastic processes such as idiopathic cholestasis can also occur [ 8 ].…”

A Unique Case of Primary Hepatic CD30-Positive, CD15-Negative Classical Hodgkin’s Lymphoma Presenting as Fever of Unknown Origin and Acute Hepatic Failure

“…Common symptoms of patients with unrecognized HL include prolonged fever, weight loss and night sweats, experienced by 67%, 67%, and 19% respectively in one series [9]. Febrile cholestatic disease as an initial presentation of NLPHL has been reported [10]. Marinone, et al [11] described two cases of HL confined to the liver and bone marrow without systemic lymph node involvement presenting as acute cholestatatic disease.…”

Hodgkin's disease presenting as discharging neck sinuses and a mediastinal mass

“…Unusual presentations of Hodgkin’s disease have been reported in literature including an association with HIV,6 a markedly elevated IgE,7 with heart failure,8 as vertebral osteomyelitis,9 a solitary skeletal lesion,10 primary cardiac lymphoma,11 a febrile cholestatic disease,12 primary hepatic presentation,13 in adrenal gland14 and with a traumatic thoracic haematoma 15…”