Department of Hemato-Oncology, An-Najah National University Hospital, Nablus, Palestinian Territory, Occupied.
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestinian Territory, Occupied.
Am J Case Rep. 2022 Feb 21;23:e935045. doi: 10.12659/AJCR.935045.
BACKGROUND Hodgkin lymphoma is a type of lymphoid neoplasm characterized by the presence of Reed-Sternberg cells in histopathology. It presents with swollen lymph nodes, and in advanced cases, it can involve bone marrow. Isolated and primary involvement of Hodgkin lymphoma in bone marrow is a very rare presentation, especially in an HIV-negative patient, and has a high mortality rate, even with appropriate management. CASE REPORT A 36-year-old male patient presented with a 6-month history of chills, night sweats, and generalized weakness. Laboratory investigations showed pancytopenia. A peripheral blood smear was unremarkable. A bone marrow biopsy revealed Reed-Sternberg cells, consistent with Hodgkin lymphoma. Further imaging did not show any lymphadenopathy, and the spleen was normal. Therefore, primary bone marrow Hodgkin lymphoma was diagnosed at stage IV, with an International Prognostic Score of 5 potential unfavorable factors. He was started on conventional chemotherapy for Hodgkin lymphoma and received the first cycle of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) during his hospitalization. Meanwhile, he had fever without focus, and was managed empirically by broad-spectrum antibiotic treatment (piperacillin-tazobactam). Hospitalization lasted for 2 weeks. He continued to receive other cycles as an outpatient, with good clinical response. The patient remained in complete remission after 2 years. CONCLUSIONS Isolated Hodgkin lymphoma of bone marrow is a very rare scenario, especially in HIV-negative patients, with no established management for patients. Here, we report a patient successfully treated with a conventional chemotherapy protocol for Hodgkin lymphoma.
霍奇金淋巴瘤是一种淋巴肿瘤，其组织病理学特征为存在里德-斯特恩伯格细胞。它表现为淋巴结肿大，在晚期病例中，可能累及骨髓。骨髓中孤立性和原发性霍奇金淋巴瘤的表现非常罕见，特别是在 HIV 阴性患者中，即使采用适当的治疗，死亡率也很高。
一名 36 岁男性患者因 6 个月的寒战、盗汗和全身乏力就诊。实验室检查显示全血细胞减少。外周血涂片未见异常。骨髓活检显示里德-斯特恩伯格细胞，符合霍奇金淋巴瘤。进一步的影像学检查未显示任何淋巴结肿大，脾脏正常。因此，诊断为 IV 期原发性骨髓霍奇金淋巴瘤，国际预后评分（IPS）为 5 分（有 5 个不利因素）。他开始接受常规霍奇金淋巴瘤化疗，并在住院期间接受了 ABVD（阿霉素、博来霉素、长春碱和达卡巴嗪）的第一个周期。同时，他出现了无明确病灶的发热，经验性给予广谱抗生素治疗（哌拉西林他唑巴坦）。住院治疗持续了 2 周。他继续作为门诊患者接受其他周期的治疗，临床反应良好。2 年后，患者完全缓解。
骨髓中孤立性霍奇金淋巴瘤非常罕见，特别是在 HIV 阴性患者中，目前尚无针对该疾病的既定治疗方法。在这里，我们报告了一名患者成功接受了霍奇金淋巴瘤常规化疗方案的治疗。
