Non-Hodgkin’s Lymphoma

Patient presentation:
J.M., a 57 year-old woman with a 20 plus history of myasthenia gravis presented to the ER with increased fatigue, severe muscle weakness, and a general feeling of “sickness”.  The patient denied any other significant history, but was on several medications around the clock to control the symptoms of her disease.  According to the patient her symptoms had been getting progressively worse for several weeks, but the patient was waiting for her regular doctor visit to be checked, as she assumed it could be attributed to the myasthenia gravis.

Upon arrival to the ER the patient’s blood pressure was dangerously low, with the systolic number sustaining in the 70’s and 80’s.  Two fluid boluses of normal saline (500ml each) were administered in the ER without any successful resolution of the hypotension.  Physical examination by the ER doctor revealed bilateral inguinal swelling.  The patient was then transferred to the MICU for blood pressure management with a Levophed® gtt.

Diagnosis:
After the patient’s hemodynamics were stabilized a CT scan was ordered to evaluate the inguinal swelling. The CT scan revealed retroperitoneal and inguinal lymphadenopathy that was felt to resemble lymphoma.  The patient also underwent a biopsy of the right groin, and was diagnosed as non-Hodgkin’s lymphoma.  At this time the medical team consulted oncology and a PET scan was ordered to get more conclusive information regarding the lymphoma.  The oncology team diagnosed the patient with stage III lymphoma after the PET scan showed abnormalities in the retroperitoneal, pelvic, spleen and inguinal nodes.

Treatment/prognosis:
The prognosis for stage III lymphoma is still quite good, with survival rates after five years ranging 70-80%.  The patient did not stay in the MICU for treatment, but two chemotherapy drugs commonly used in the treatment of lymphoma are alkylating agents and nucleosides.  Alkylating agents inhibit cell division by altering the DNA of cancer cells.  Nucleosides inhibit DNA and RNA consequently stopping cancer cells from growing.

Outcome:
The patient was transferred to an oncology unit to begin aggressive chemotherapy and radiation.  At the time of transfer the patient was in better standing with pain control, and all vitals were stable.  Patient was also in good spirits, as she was now diagnosed and able to start battling her lymphoma.
Case created by Jessica Mazzone, 2010.