Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2024.490
Autopsy and Case Reports
Autopsy Case Report

Acute liver failure caused by lymphocyte-depleted Hodgkin lymphoma in tuberculosis and HIV-infected patient

Mayur Parkhi; Madhumita Premkumar; Amanjit Bal; Ashim Das; Sanjay Jain; Suvradeep Mitra

Downloads: 0
Views: 287

Abstract

The lymphocyte-depleted classic Hodgkin lymphoma (LDCHL), the rarest subtype of classic Hodgkin lymphoma (CHL), is usually diagnosed at an advanced stage (stage IV) and one that unusually involves the liver, causing a rapidly progressive clinical course. We describe a 40-year-old immunocompromised man presenting with a progressive non-cholestatic jaundice and intermittent fever. The abdominal ultrasonography revealed a nodular liver with coarse echotexture and periportal hypodensities. The thoracic and abdominal contrast-enhanced computed tomography revealed right cervical and paraaortic lymphadenopathy, hepatosplenomegaly, diffuse mural thickening of duodenal and jejunal loops, and bilateral lobulated kidneys. Subsequently, he succumbed to his illness secondary to refractory septic shock. On postmortem examination, he was diagnosed with classic Hodgkin lymphoma (lymphocyte-depleted type) involving paraaortic and mediastinal lymph nodes based on morphology and immunochemistry findings. The lymphomatous process involved the liver (causing multiacinar confluent hepatic necrosis) and spleen, both showing tuberculous foci. This autopsy case depicts an uncommon case of acute liver failure due to infiltration of the liver by LDCHL in an HIV-infected patient. The findings of angiotropism and angioinvasion establish the pathological mechanism of liver failure (hepatocellular necrosis) in such cases.

Keywords

Hodgkin Lymphoma, Liver failure, Acute, HIV, Tuberculosis

References

1 Major A, Jackson MW, Smith DE, Kamdar M, Rabinovitch R. Inferior outcomes and treatment disparities in elderly patients with classical Hodgkin lymphoma: a national cancer database analysis. Leuk Lymphoma. 2019;60(5):1234-43. http://doi.org/10.1080/10428194.2018.1522435. PMid:30501432.

2 Eberle FC, Mani H, Jaffe ES. Histopathology of Hodgkin’s lymphoma. Cancer J. 2009;15(2):129-37. http://doi.org/10.1097/PPO.0b013e31819e31cf. PMid:19390308.

3 Karube K, Niino D, Kimura Y, Ohshima K. Classical Hodgkin lymphoma, lymphocyte depleted type: clinicopathological analysis and prognostic comparison with other types of classical Hodgkin lymphoma. Pathol Res Pract. 2013;209(4):201-7. http://doi.org/10.1016/j.prp.2012.11.003. PMid:23478005.

4 Mauch PM, Kalish LA, Kadin M, Coleman CN, Osteen R, Hellman S. Patterns of presentation of Hodgkin disease. Implications for aetiology and pathogenesis. Cancer. 1993;71(6):2062-71. http://doi.org/10.1002/1097-0142(19930315)71:6<2062::AID-CNCR2820710622>3.0.CO;2-0. PMid:8443755.

5 Shiels MS, Koritzinsky EH, Clarke CA, Suneja G, Morton LM, Engels EA. Prevalence of HIV Infection among U.S. Hodgkin lymphoma cases. Cancer Epidemiol Biomarkers Prev. 2014;23(2):274-81. http://doi.org/10.1158/1055-9965.EPI-13-0865. PMid:24326629.

6 Schwering I, Bräuninger A, Klein U, et al. Loss of the B-lineage-specific gene expression program in Hodgkin and Reed-Sternberg cells of Hodgkin lymphoma. Blood. 2003;101(4):1505-12. http://doi.org/10.1182/blood-2002-03-0839. PMid:12393731.

7 Borges AM, Delabie J, Vielh P, et al. Classic Hodgkin Lymphoma. In: WHO Classification of Tumours Editorial Board. Haematolymphoid tumours. Lyon: International Agency for Research on Cancer; 2022.

8 Green MR, Rodig S, Juszczynski P, et al. Constitutive AP-1 activity and EBV infection induce PD-L1 in Hodgkin lymphomas and posttransplant lymphoproliferative disorders: implications for targeted therapy. Clin Cancer Res. 2012;18(6):1611-8. http://doi.org/10.1158/1078-0432.CCR-11-1942. PMid:22271878.

9 Imbeault M, Ouellet M, Giguère K, et al. Acquisition of host-derived CD40L by HIV-1 in vivo and its functional consequences in the B-cell compartment. J Virol. 2011;85(5):2189-200. http://doi.org/10.1128/JVI.01993-10. PMid:21177803.

10 Trewby PN, Portmann B, Brinkley DM, Williams R. Liver disease as presenting manifestation of Hodgkin’s disease. Q J Med. 1979;48(189):137-50. PMid:482587.

11 Karmacharya P, Bhandari N, Aryal MR, et al. Before it crumbles: fulminant hepatic failure secondary to Hodgkin’s Lymphoma. J Community Hosp Intern Med Perspect. 2014;4(5):25821. http://doi.org/10.3402/jchimp.v4.25821. PMid:25432655.

12 Murakami J, Shimizu Y. Hepatic manifestations in hematological disorders. Int J Hepatol. 2013;2013:484903. http://doi.org/10.1155/2013/484903. PMid:23606974.

13 Mihăilă RG. Liver Involvement in Hodgkin’s Lymphoma: types of injuries and therapeutic implications. Int J Pharmacol Phytochem Ethnomed. 2017;8:1-15. http://doi.org/10.18052/www.scipress.com/IJPPE.8.1.

14 Reddy RC, Mathew M, Parameswaran A, Narasimhan R. A case of concomitant Hodgkin’s lymphoma with tuberculosis. Lung India. 2014;31(1):59-62. http://doi.org/10.4103/0970-2113.125985. PMid:24669086.

15 Kaplan MH, Armstrong D, Rosen P. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer. 1974;33(3):850-8. http://doi.org/10.1002/1097-0142(197403)33:3<850::AID-CNCR2820330334>3.0.CO;2-H. PMid:4592905.

16 Banerjee A, Bhuller K, Sudhir R, Bajaj A. Diagnostic dilemma of Hodgkin’s lymphoma versus tuberculosis: a case report and review of the literature. J Med Case Rep. 2021;15(1):351. http://doi.org/10.1186/s13256-021-02927-x. PMid:34275479.

17 El Bouhmadi K, Oukessou Y, Rouadi S, Abada R, Roubal M, Mahtar M. Association of multifocal Hodgkin’s lymphoma and tuberculosis infection: a challenging entity. Int J Surg Case Rep. 2022;90:106711. http://doi.org/10.1016/j.ijscr.2021.106711. PMid:34952310.

18 Mustafa Ali M, Ruano Mendez AL, Carraway HE. Hemophagocytic Lymphohistiocytosis in a patient with hodgkin lymphoma and concurrent EBV, CMV, and candida infections. J Investig Med High Impact Case Rep. 2017;5(1):2324709616684514. http://doi.org/10.1177/2324709616684514. PMid:28210636.

19 Tabaja H, Kanj A, El Zein S, Comba IY, Chehab O, Mahmood M. A review of hemophagocytic lymphohistiocytosis in patients with HIV. Open Forum Infect Dis. 2022 Feb 11;9(4):ofac071. http://doi.org/10.1093/ofid/ofac071.
 


Submitted date:
01/07/2024

Accepted date:
04/04/2024

Publication date:
05/22/2024

664e276fa953954e754cc7f2 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections