Hodgkin's lymphoma

Patient Presentation:
RJP, a 50 year old male, presents to the ER with a non-productive cough, weakness, nausea, and with a temp of 39.1. He has a history of ulcerative colitis post ileostomy and anal squamous cell carcinoma status post radiation. VS: heart rate 114 Bp 110/70 and 92% on RA.

Labs were immediately sent and pan cultures (blood cultures x2 and urine culture) collected and a CXR completed. His H/H was 10.8/35.3, WBC 15.9, Bicarb of 16 and BUN of 33, creatinine 1.

Treatment:
Patient was started on broad-spectrum antibiotics of vancomycin and meropenem pending culture results. RJP continued to be febrile despite antibiotics. He started requiring 4 L of oxygen. The patient had a chest CT which showed extensive ground-glass opacities throughout bilateral lung fields. Multiple new bilateral scattered nodular peripheral densities were more evident at the lung bases and were more numerous and larger the a previous study. The patient underwent a VATS procedure for right middle lobe and right lower lobe biopsy, and level 7 lymph node was also biopsied.

Diagnosis:
The pathology reports confirmed patient had Hodgkin's lymphoma. He had a PET CT of neck, chest, abdomen, and pelvis which showed no definite evidence of malignant disease. The medical team concluded that the steroid treatment he had been receiving for ulcerative colitis had suppressed the metabolic activity from the lymphoma.

Outcome:
RJP was started on chemotherapy which included chlorambucil, vinblastine, procarbazine, and prednisone. He was able to be weaned down to 2L on O2 and afebrile. The patient was eventually discharged to a nursing home.

Case created by Rachel Petrus, 2012.