Kobayashi Hiroshi, Seki Ryouya, Ujita Masuo, Hirayama Kana, Yamada Satoshi, Ohashi Riuko, Otsuki Yoshiro, Watanabe Takuya, Yoshino Tadashi
Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan.
Department of of Gastroenterology, Tachikawa General Hopspital, Nagaoka, Niigata, Japan.
Am J Case Rep. 2020 Oct 22;21:e926177. doi: 10.12659/AJCR.926177.
BACKGROUND Hodgkin lymphoma (HL) is a potentially curable disease with favorable outcomes. However, elderly patients with HL usually have more adverse prognostic factors and hence a much worse prognosis than younger patients. CASE REPORT The patient was a woman in her 80s. She reported high fever, anorexia, and a weight loss of 8 kg within 5 months. She had been on treatment for diabetes mellitus and hypertension. She had undergone percutaneous coronary intervention and pacemaker implantation to treat acute coronary syndrome and sinus arrhythmia, respectively. Blood tests showed elevation of alkaline phosphatase, C-reactive protein, leukocyte count, CA 19-9, and carcinoembryonic antigen. Computed tomography did not show tumors in the liver, and cholangitis and sepsis were suspected. Aspartate transaminase, alanine aminotransferase, and total bilirubin gradually increased through the course of the patient's hospital stay. Despite treatment, her condition deteriorated and she died 22 days after hospital admission. At autopsy, we found stage IV HL with lymph node swelling on both sides of the diaphragm, as well as diffusely disseminated nodules in the liver and spleen. CONCLUSIONS Our patient had several poor prognostic factors including B symptoms, comorbidity, advanced stage, Epstein-Barr virus infection, and expression of programmed death-ligand 1 and interleukin-6, all of which were closely connected with her advanced age. Her age and comorbidities may have been the most adverse prognostic factors for her illness. An effective HL screening method for elderly individuals should be developed to ameliorate poor prognosis and adverse outcomes.
背景 霍奇金淋巴瘤（HL）是一种有潜在治愈可能且预后良好的疾病。然而，老年HL患者通常有更多不良预后因素，因此预后比年轻患者差得多。病例报告 患者为一名80多岁的女性。她报告有高热、厌食，且在5个月内体重减轻了8千克。她一直在接受糖尿病和高血压治疗。她分别接受了经皮冠状动脉介入治疗和起搏器植入术以治疗急性冠状动脉综合征和窦性心律失常。血液检查显示碱性磷酸酶、C反应蛋白、白细胞计数、CA 19-9和癌胚抗原升高。计算机断层扫描未显示肝脏有肿瘤，怀疑有胆管炎和败血症。在患者住院期间，天冬氨酸转氨酶、丙氨酸转氨酶和总胆红素逐渐升高。尽管进行了治疗，但她的病情仍恶化，入院22天后死亡。尸检时，我们发现患者为IV期HL，双侧膈肌淋巴结肿大，肝脏和脾脏有弥漫性分布的结节。结论 我们的患者有几个不良预后因素，包括B症状、合并症、晚期、爱泼斯坦-巴尔病毒感染以及程序性死亡配体1和白细胞介素-6的表达，所有这些都与她的高龄密切相关。她的年龄和合并症可能是其疾病最不利的预后因素。应开发一种针对老年人的有效的HL筛查方法，以改善不良预后和不良结局。
