SHM Converge Scientific Abstract ePoster Gallery-Double Trouble: Lymphocyte-Depleted Classical Hodgkin Lymphoma Presenting as Hemophagocytic Lymphohistiocytosis

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This case describes a 65-year-old woman who presented with three months of shortness of breath, weight loss, fever, hypotension, and tachycardia. Her labs showed severe anemia, thrombocytopenia, and markedly elevated ferritin, raising concern for hemophagocytic lymphohistiocytosis (HLH). Her H-score was 187, supporting a high probability of HLH.<br /><br />HLH is a rare, life-threatening hyperinflammatory syndrome caused by excessive immune activation and can progress to multiorgan failure. Diagnosis is typically made when 5 of 8 HLH criteria are met, including fever, splenomegaly, cytopenias, hypertriglyceridemia or hypofibrinogenemia, hemophagocytosis, low NK-cell activity, hyperferritinemia, and elevated soluble IL-2 receptor. In this case, persistent fever, very high ferritin, liver dysfunction, cytopenias, triglyceride elevation, and elevated soluble IL-2 receptor supported the diagnosis.<br /><br />Dexamethasone was started according to the HLH-2004 protocol, but the patient rapidly worsened, developing respiratory failure and shock requiring intubation and vasopressors. CT imaging showed extensive lymphadenopathy, and biopsy of a left supraclavicular node confirmed lymphocyte-depleted classical Hodgkin lymphoma (LDCHL). Bone marrow biopsy showed no lymphoma involvement.<br /><br />The case highlights that HLH may be triggered by an underlying malignancy, especially lymphoma, and that patients with HLH should be evaluated promptly for cancer. LDCHL is a rare and aggressive subtype of Hodgkin lymphoma associated with poor outcomes. Management is challenging because both the inflammatory syndrome and the cancer must be addressed, often requiring a multidisciplinary approach.

Asset Subtitle

Jessica Igiede

Meta Tag

Author List Jessica Igiede, Melissa Gunchenko, Michelle Sweet

Category Clinical Vignettes

Concept Secondary hemophagocytic lymphohistiocytosis

Concept HLH-04 criteria

Concept Cytopenia

Concept Lymphoma

Concept Malignancy-Associated Hemophagocytic Lymphohistiocytosis

Distinguished Non-Finalist

Presenter Organization Rush Medical College

Presenting Author Jessica Igiede

Track Adult

Keywords

hemophagocytic lymphohistiocytosis

HLH

H-score

lymphocyte-depleted classical Hodgkin lymphoma

LDCHL

hyperferritinemia

cytopenias

dexamethasone

lymphadenopathy

multiorgan failure

Secondary hemophagocytic lymphohistiocytosis

HLH-04 criteria

Cytopenia

Lymphoma

Malignancy-Associated Hemophagocytic Lymphohistiocytosis