Bartus Cynthia L, Parker Sareeta R S
Emory University School of Medicine, Atlanta, Georgia, USA.
Cutis. 2011 Apr;87(4):169-72.
Pruritus is a common manifestation of Hodgkin lymphoma (HL), and given its high frequency, inclusion of itching as a B symptom of HL has been proposed. We present a 16-year-old adolescent boy with treatment-refractory eczema of 2 years' duration. Physical examination revealed a thin adolescent boy with widespread excoriations, but no eczematous or primary cutaneous lesions were identifiable. Lymph node examination revealed palpably enlarged nodes in the cervical and supraclavicular regions. Laboratory studies revealed leukocytosis and an elevated lactate dehydrogenase level. Diffuse lymphadenopathy was detected on a chest radiograph, and excisional lymph node biopsy revealed HL (nodular sclerosing subtype). The patient was classified as HL stage IIIB (Ann Arbor staging classification) after further evaluation. Chemotherapy was initiated followed by radiation therapy. The patient's pruritus markedly improved within 2 cycles of chemotherapy; however, his HL relapsed and additional salvage combination chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant were required. This case underscores the need for a complete history as well as a careful skin and systemic evaluation in patients presenting with long-term pruritus, including children and adolescents.
瘙痒是霍奇金淋巴瘤（HL）的常见表现，鉴于其高发性，有人提议将瘙痒纳入HL的B症状。我们报告一名16岁的青少年男性，患有持续2年的难治性湿疹。体格检查发现该瘦弱青少年全身多处有抓痕，但未发现湿疹或原发性皮肤病变。淋巴结检查发现颈部和锁骨上区域可触及肿大的淋巴结。实验室检查显示白细胞增多和乳酸脱氢酶水平升高。胸部X线片显示弥漫性淋巴结病，切除性淋巴结活检显示为HL（结节硬化亚型）。进一步评估后，患者被分类为HL IIIB期（Ann Arbor分期分类）。开始化疗，随后进行放射治疗。患者的瘙痒在化疗2个周期内明显改善；然而，他的HL复发，需要进行额外的挽救性联合化疗，随后进行大剂量化疗和自体干细胞移植。该病例强调，对于出现长期瘙痒的患者，包括儿童和青少年，需要详细的病史以及仔细的皮肤和全身评估。
