An autopsy case of an elderly patient with classic hodgkin lymphoma presenting with a plethora of clinical symptoms and signs

Hiroshi Kobayashi, Ryouya Seki, Masuo Ujita, Kana Hirayama, Satoshi Yamada, Riuko Ohashi, Yoshiro Otsuki, Takuya Watanabe, Tadashi Yoshino

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article numbere926177
Pages (from-to)1-9
Number of pages9
JournalAmerican Journal of Case Reports
Volume21
DOIs
Publication statusPublished - 2020

Keywords

  • Antigens, CD274
  • Epstein-Barr Virus Infections
  • Hodgkin Disease
  • Interleukin-6
  • Prognosis

ASJC Scopus subject areas

  • Medicine(all)

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