A Rare Case of Immune Thrombocytopenic Purpura in a Patient With Hodgkin Lymphoma: A Diagnostic Dilemma

Otokiti, O ; Bolarinwa, A ; Ogbenna, A (2018)

Scholarly article

Article

Introduction: Paraneoplastic syndrome is a collective term for disorders arising from metabolic effects of cancer on tissues remote from the primary tumor. Such disorders maybe endocrine, hematologic, or neuromuscular disorders. Immune thrombocytopenia (ITP) is a rare PNS manifestation in Hodgkin lymphoma (HL). The prevalence of ITP associated with HL is unknown in Nigeria as there are few or no case reports. It is more common in males and is associated with autoimmune antibodies. Case Presentation: We present a 49-year-old man who presented with swelling on the tongue with numerous hemorrhagic bullaes and ecchymosis. He had a small lymph node in the right axilla and another in the inguinal region. Lymph node biopsy came out as benign lymphoid hyperplasia. A diagnosis of ITP was made based on severe thrombocytopenia, megakaryocytic hyperplasia, and a negative viral serology. He responded well to steroid but was switched to Eltrombobag when he became refractory to steroids. A repeat biopsy was done 5 months after, due to increasing right axillary lymphadenopathy that revealed a nodular lymphocyte-predominate HL (NLPHL). He requested to travel to India for further care. In India, he had six cycles of ABVD with rituximab. PET/CT scan after the second cycle showed a partial treatment response and after the sixth cycle showed complete resolution of right axillary lymph nodes. Platelet count has been within normal range and patient is alive and well. Conclusion: Hodgkin lymphoma can be associated with paraneoplastic hematologic syndromes, one of which is ITP. This could precede diagnosis of HL as in this case or present concomitantly. Sometimes it could be the only presenting feature of an underlying HL posing as a diagnostic dilemma. Therefore, a high index of suspicion is required to avoid diagnostic delay. Successful treatment of HL often reverses the hematologic paraneoplastic manifestations.