TY - JOUR
T1 - An autopsy case of an elderly patient with classic hodgkin lymphoma presenting with a plethora of clinical symptoms and signs
AU - Kobayashi, Hiroshi
AU - Seki, Ryouya
AU - Ujita, Masuo
AU - Hirayama, Kana
AU - Yamada, Satoshi
AU - Ohashi, Riuko
AU - Otsuki, Yoshiro
AU - Watanabe, Takuya
AU - Yoshino, Tadashi
N1 - Publisher Copyright:
© Am J Case Rep.
PY - 2020
Y1 - 2020
N2 - Patient: Female, 88-year-old Final Diagnosis: Hodgkin lymphoma Symptoms: Fever • weight loss • dypnea Medication: — Clinical Procedure: — Specialty: Pathology Objective: Background: Unusual clinical course Hodgkin lymphoma (HL) is a potentially curable disease with favorable outcomes. However, elderly patients with HL usually have more adverse prognostic factors and hence a much worse prognosis than younger patients. Case Report: The patient was a woman in her 80s. She reported high fever, anorexia, and a weight loss of 8 kg within 5 months. She had been on treatment for diabetes mellitus and hypertension. She had undergone percutane-ous coronary intervention and pacemaker implantation to treat acute coronary syndrome and sinus arrhyth-mia, respectively. Blood tests showed elevation of alkaline phosphatase, C-reactive protein, leukocyte count, CA 19-9, and carcinoembryonic antigen. Computed tomography did not show tumors in the liver, and cholan-gitis and sepsis were suspected. Aspartate transaminase, alanine aminotransferase, and total bilirubin gradu-ally increased through the course of the patient’s hospital stay. Despite treatment, her condition deteriorated and she died 22 days after hospital admission. At autopsy, we found stage IV HL with lymph node swelling on both sides of the diaphragm, as well as diffusely disseminated nodules in the liver and spleen. Conclusions: Our patient had several poor prognostic factors including B symptoms, comorbidity, advanced stage, Epstein-Barr virus infection, and expression of programmed death-ligand 1 and interleukin-6, all of which were close-ly connected with her advanced age. Her age and comorbidities may have been the most adverse prognostic factors for her illness. An effective HL screening method for elderly individuals should be developed to amelio-rate poor prognosis and adverse outcomes.
AB - Patient: Female, 88-year-old Final Diagnosis: Hodgkin lymphoma Symptoms: Fever • weight loss • dypnea Medication: — Clinical Procedure: — Specialty: Pathology Objective: Background: Unusual clinical course Hodgkin lymphoma (HL) is a potentially curable disease with favorable outcomes. However, elderly patients with HL usually have more adverse prognostic factors and hence a much worse prognosis than younger patients. Case Report: The patient was a woman in her 80s. She reported high fever, anorexia, and a weight loss of 8 kg within 5 months. She had been on treatment for diabetes mellitus and hypertension. She had undergone percutane-ous coronary intervention and pacemaker implantation to treat acute coronary syndrome and sinus arrhyth-mia, respectively. Blood tests showed elevation of alkaline phosphatase, C-reactive protein, leukocyte count, CA 19-9, and carcinoembryonic antigen. Computed tomography did not show tumors in the liver, and cholan-gitis and sepsis were suspected. Aspartate transaminase, alanine aminotransferase, and total bilirubin gradu-ally increased through the course of the patient’s hospital stay. Despite treatment, her condition deteriorated and she died 22 days after hospital admission. At autopsy, we found stage IV HL with lymph node swelling on both sides of the diaphragm, as well as diffusely disseminated nodules in the liver and spleen. Conclusions: Our patient had several poor prognostic factors including B symptoms, comorbidity, advanced stage, Epstein-Barr virus infection, and expression of programmed death-ligand 1 and interleukin-6, all of which were close-ly connected with her advanced age. Her age and comorbidities may have been the most adverse prognostic factors for her illness. An effective HL screening method for elderly individuals should be developed to amelio-rate poor prognosis and adverse outcomes.
KW - Antigens, CD274
KW - Epstein-Barr Virus Infections
KW - Hodgkin Disease
KW - Interleukin-6
KW - Prognosis
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U2 - 10.12659/AJCR.926177
DO - 10.12659/AJCR.926177
M3 - Article
C2 - 33087692
AN - SCOPUS:85094167568
VL - 21
SP - 1
EP - 9
JO - American Journal of Case Reports
JF - American Journal of Case Reports
SN - 1941-5923
M1 - e926177
ER -