Primary Bone Marrow HIV-Associated Hodgkin Lymphoma Complicated by Hemophagocytic Lymphohistiocytosis

Abstract

The presentation of human immunodeficiency virus (HIV)-associated Hodgkin lymphoma can differ from that of the general population. More specifically, primary bone marrow Hodgkin lymphoma is an uncommon presentation that is more often reported in patients with HIV. Given the many overlapping symptoms of Hodgkin lymphoma and HIV as well as HIV-associated infections, diagnosis can be difficult and delayed. We describe a case of primary bone marrow HIV-associated Hodgkin lymphoma complicated by hemophagocytic lymphohistiocytosis (HLH) where the initial work-up was inconclusive. Our case demonstrates the importance of early consideration of HLH as well as the need for an early bone marrow biopsy in a cytopenic patient with a fever of unknown origin.

Primary Bone Marrow Hodgkin’s Lymphoma Debuting As Hemophagocytic Lymphohistiocytosis in a Patient With HIV

“…Further complicating the diagnoses is ferritin, being an inflammatory marker, can be elevated in both infection and HLH and has also been shown to be markedly elevated in patients with untreated/undiagnosed classic HL [ 4 ]. Our literature review found only two additional cases reporting PBMHL with HLH as a complication [ 6 , 7 ]. In those two cases and in our patient, HL in the bone marrow, along with the development of HLH, made this case challenging to manage and diagnose since the symptoms may overlap with each other.…”

Hemophagocytic Lymphohistiocytosis Secondary to Hodgkin’s Lymphoma with Isolated Bone Marrow Involvement in a Newly Diagnosed HIV Patient

“…As in some other cases described in the literature, the coincidence of HL in the bone marrow together with the development of HLH made this case difficult to manage and diagnose, since the symptoms may overlap with each other, making interpretation difficult [ 13 , 14 ].…”