SHM Converge Scientific Abstract ePoster Gallery-A (Not So) Classical Presentation of Classical Hodgkin Lymphoma

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This case describes a 44-year-old woman with rheumatoid arthritis who had recently started methotrexate and infliximab and presented twice within one month with fever, malaise, night sweats, abdominal discomfort, hypotension, bradycardia, hypothermia, and pancytopenia. She was treated as having septic shock on both admissions, but infectious evaluation was repeatedly negative. Initial peripheral blood smear and flow cytometry showed no leukemia or lymphoma. CT imaging revealed splenomegaly and generalized lymphadenopathy, which progressed on repeat imaging.<br /><br />Because her symptoms persisted despite empiric antibiotics and no infection was identified, clinicians pursued noninfectious causes. A bone marrow biopsy showed partial marrow replacement by classical Hodgkin lymphoma with a marked granulomatous reaction. She improved after glucocorticoid therapy and then received systemic chemoimmunotherapy, with resolution of pancytopenia, dysautonomia, and constitutional symptoms.<br /><br />The report emphasizes that Hodgkin lymphoma is a B-cell neoplasm characterized by Hodgkin/Reed-Sternberg cells in a mixed inflammatory background and usually presents with painless lymphadenopathy and B symptoms. However, rare advanced cases may present with a sepsis-like syndrome and autonomic dysfunction, likely related to cytokine-mediated vasodilation and paraneoplastic effects on the autonomic nervous system.<br /><br />The key lesson is that persistent SIRS-like illness with negative infectious studies should prompt consideration of malignancy, including Hodgkin lymphoma, especially when imaging shows lymphadenopathy or splenomegaly. Early recognition is important because Hodgkin lymphoma is often curable, and delayed diagnosis can postpone life-saving treatment.

Asset Subtitle

Lena Makartian

Meta Tag

Author List Adam Zayac, Jason D. Lofters, Lena Makartian, Sharmela Brijmohan, Sofia Terner, Veronica Jacome Lopez

Category Clinical Vignettes

Concept Hodgkin Lymphoma

Concept Hodgkin/Reed-Sternberg Cells

Concept Malignancy

Concept Sepsis-like illness

Concept Systemic Inflammatory Response Syndrome

Distinguished Non-Finalist

Presenter Organization Englewood Hospital and Medical Center

Presenting Author Lena Makartian

Track Adult

Keywords

Hodgkin lymphoma

rheumatoid arthritis

methotrexate

infliximab

septic shock

pancytopenia

lymphadenopathy

splenomegaly

bone marrow biopsy

dysautonomia

Hodgkin Lymphoma

Hodgkin/Reed-Sternberg Cells

Malignancy

Sepsis-like illness

Systemic Inflammatory Response Syndrome