Long-Term Survival of a Patient With Human Immunodeficiency Virus Infection and Hodgkin's Lymphoma

A. Hafeez Diwan, MD, Phd, Jay Umbreit, MD, Beverly P. Nelson, MD

Disclosures

South Med J. 2002;95(8) 

In This Article

Case Report

This 29-year-old bisexual white man was admitted to the hospital in September 1990 for evaluation of syncopal episodes. Admission physical examination showed splenomegaly and axillary lymphadenopathy; laboratory data showed severe leukopenia (white blood cell count 2,100/mm3), anemia (hemoglobin value, 6 g/dL), and normal platelet count (249,000/mm3). Biopsy of an axillary lymph node 4 days after admission yielded histologic findings consistent with follicular hyperplasia. Flow cytometric immunophenotyping studies done on a sample from the initial lymph node biopsy revealed 20% B cells and 75% T cells with reduced ratio (0.75) of helper T cells (CD4) to suppressor T cells (CD8). Absolute values of CD4 were not reported. Human immunodeficiency virus infection was subsequently diagnosed with enzyme-linked immunosorbent assay and confirmed by Western blot analysis. Repeated axillary lymph node biopsy 2 weeks after admission led to a diagnosis of HL, lymphocyte depletion type. However, review of the earlier histologic sections showed nodules composed of lacunar-type Reed-Sternberg cells, small lymphocytes, and plasma cells separated by birefringent collagen bands, findings more compatible with the nodular sclerosis type of HL. A staging bone marrow biopsy showed extensive involvement, and stage IV HL was diagnosed.

Computed tomography of the abdomen 1 day after admission showed right subcrural and periaortic lymphadenopathy, as well as splenomegaly. An admission chest x-ray film did not show active cardiopulmonary disease or hilar adenopathy.

The patient received one round of chemotherapy, MOPP-ABV (nine cycles of nitrogen mustard, vincristine, procarbazine, and prednisone [MOPP], alternating with Adriamycin [doxorubicin], bleomycin, and vinblastine [ABV]). After this course, the patient was found to be free of HL. However, 3 years later, in December 1993, right cervical lymphadenopathy recurred. Biopsy of the cervical lymph node showed recurrent nodular sclerosis HL. Staging bone marrow biopsy showed a normocellular specimen without evidence of HL. Another round of MOPP-ABV (4 cycles) was administered, and the patient achieved complete remission. Seven months later, in July 1994, the patient was hospitalized for treatment of Pneumocystis carinii pneumonia, herpes simplex viral infection, oral candidiasis, and pulmonary cytomegalovirus infection. His CD4 count at the time was 8/mm3. Bone marrow biopsy during this hospitalization did not show HL or acid-fast or fungal organisms. He was treated and discharged in August 1994 and was lost to follow-up until 4 years later, when he presented with localized axillary adenopathy in March 1998. Lymph node biopsy showed follicular hyperplasia and other reactive changes.

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