Hodgkin’s lymphoma after 2-month infliximab therapy: case report

Saeidi, Sajedeh; Ahmadzadeh, Ahmad; Rajaei, Elham; Rahim, Fakher; Jazayeri, Seyed Nematollah; Shahjahani, Mohammad; Saki, Najmaldin

doi:10.1007/s00580-014-2007-6

Cited by 1 publication

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“…It is presumed that immunosuppressant therapy in the treatment of inflammatory bowel disease plays a role in facilitating infection and thus predisposing to secondary HLH [ 13 ]. In particular, infliximab is independently associated with the development of Hodgkin lymphoma, as well as secondary HLH [ 14 , 15 ]. Having both Crohn disease (an autoimmune process) and a hematologic malignancy may have put our patient at increased risk of developing secondary HLH.…”

Section: Discussionmentioning

confidence: 99%

Hemophagocytic Lymphohistiocytosis Secondary to Unknown Underlying Hodgkin Lymphoma Presenting with a Cholestatic Pattern of Liver Injury

Booth

Osehobo²,

Rodgers-Soriano³

et al. 2018

Case Rep Gastroenterol

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Hemophagocytic lymphohistiocytosis (HLH) is an uncommon disease that often presents with nonspecific findings. A high index of suspicion is necessary to make a prompt diagnosis and prevent fatal disease. A 45-year-old man presented with fever, hypotension, abdominal pain, nausea, and vomiting. Imaging showed hepatosplenomegaly and laboratory tests revealed pancytopenia, increased ferritin, and a cholestatic pattern of injury with elevated alkaline phosphatase and total bilirubin. Due to a history of Crohn disease, systemic lupus erythematous, and rheumatoid arthritis, the patient was on immunosuppressants, including infliximab. After multiple negative cultures, persistent fever, and days of empiric broad spectrum antibiotics, our differential shifted to fever of unknown origin. A liver wedge biopsy revealed areas of sinusoidal dilatation with enlarged, activated macrophages containing erythrocytes and intracytoplasmic iron, consistent with hemophagocytosis due to HLH. The portal tracts showed mixed lymphoplasmacytic inflammation, a prominent bile ductular reaction, periportal fibrosis, and scattered large cells with occasional binucleation and prominent nucleoli. These cells stained positive for Epstein-Barr virus encoding region in situ hybridization, PAX5, CD15, and CD30, and hepatic involvement by classic Hodgkin lymphoma was diagnosed and determined to be the cause of the HLH and cholestatic pattern of injury. Simultaneously, a bone marrow biopsy showed diffuse involvement by Hodgkin lymphoma with a similar staining pattern. Aggressive treatment failed and the patient succumbed to multiorgan failure. HLH is a rare, potentially fatal disease, with nonspecific signs and symptoms, and should be considered in any patient presenting with fever and pancytopenia, especially if they are immune compromised.

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Section: Discussionmentioning

confidence: 99%