Tissue is the issue-sarcoidosis following ABVD chemotherapy for Hodgkin's lymphoma: a case report
© Subbiah et al; licensee BioMed Central Ltd. 2007
Received: 08 July 2007
Accepted: 25 November 2007
Published: 25 November 2007
Thirty two year old Caucasian female presented 2 months post partum with fevers, cough and shortness of breath. CT scan of the chest to rule out pulmonary embolism revealed mediastinal lymphadenopathy. Biopsy of the nodes revealed classic Hodgkin's lymphoma and she received ABVD chemotherapy. She was in remission as confirmed by a PET/CT scan. Five months later she had another PET/CT scan which showed areas of hypermetabolism indicating a possible relapse. Biopsy revealed sarcoidosis. She received steroids and 18 months later remained in clinical remission. This rare case of sarcoid following classic Hodgkin's lymphoma illustrates that clinical presentation, physical exam, lab investigations and even PET/CT scans may not be able to discriminate between Hodgkin's lymphoma and sarcoidosis. Tissue biopsy and pathological diagnosis remain the gold standard.
Discussion and conclusion
Sarcoidosis is a multisystem disorder of unknown etiology characterized by non-caseating granulomas . The diagnosis is established by clinical presentation and confirmed by typical histology. In the USA it has a predilection towards females and in blacks. A sarcoidosis-lymphoma association has been described in which there is an increased incidence of lymphoma at least 5.5 times higher than expected in patients with sarcoidosis.  Hodgkin's lymphoma following a diagnosis of sarcoidosis is well reported in the literature and concomitant lymphoma and sarcoidosis have also been described. However, very few reports exist of sarcoid like reactions following treatment of Hodgkin's lymphoma. It has been postulated that bleomycin or other chemotherapeutic agents may precipitate a granulomatous reaction and the development of sarcoidosis but this has not been proven [6, 7]. Sarcoidosis often presents with constitutional symptoms such as fever, fatigue, malaise and weight loss but erythema nodosum may also be seen. Hodgkin's lymphoma may present with similar findings but the diagnosis relies on pathological confirmation. Treatment options for relapsed Hodgkin's lymphoma include salvage chemotherapy regimens and/or high dose chemotherapy followed by a stem cell transplant. Since these therapies are potentially very toxic, a definitive tissue confirmation of relapsed Hodgkin's is essential. Clinical presentation, physical exam, lab investigations and, as this case illustrates, even PET/CT scans may not be able to discriminate between Hodgkin's lymphoma and sarcoidosis. Tissue biopsy and pathological diagnosis remain the gold standard.
Informed consent was obtained from the patient for the publication of this case report.
Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine chemotherapy
Positron Emission Tomography/Computed Tomography
No funding source for the case report.
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