Skip to main content Skip to main navigation menu Skip to site footer

Obstructive jaundice as manifestation of relapsing Hodgkin’s Lymphoma: the success of chemotherapy (case report)

  • Fauzi Yusuf ,
  • Meutia Rizki Innayah ,
  • Desi Maghfirah ,
  • Azzaki Azzaki ,
  • M. Riswan ,

Abstract

Background: Hodgkin's lymphoma is a hematologic malignancy of lymphocyte cells. Intrahepatic or extrahepatic disorders can cause jaundice associated with lymphoma. An extrahepatic obstructive jaundice due to lymphoma is still rarely reported, the incidence is only 1.3% out of 370 patients.

Case Description: A male patient, 44 years old, admitted to the hospital because his eyes and all over his body became yellowish. He also felt itchy on his skin, and his stool color was pale. The patient was diagnosed with a post-chemotherapy relapse of Hodgkin's lymphoma twice with different regimens. The first chemotherapy was with the CHOP regimen. We evaluated the patient nine months after the chemotherapy with abdominal CT-scan, and we found paraaortic lymphadenopathy with infiltration to the spleen and gaster. Then, the patient was re-chemotherapy using Mesna's ICE regimen. Seven months after the second chemotherapy, the patient was re-admitted to the hospital with jaundice throughout his body. His laboratory results were 25.3 mg/dl for total bilirubin, 21.5 for direct bilirubin, 199 U/L for AST, 213 U/L for ALT, 469 mg/dl for ALP, and 6,400/mm3 for leukocytes. We found gall bladder hydrops and Intra-Hepatic Bile Duct Dilatation (IHBD) during an abdominal ultrasound examination. The results of the PET-scan showed multiple metastases to the peritoneal/omentum and diffuse lymphomatous infiltration in the gastric. After that, the patient was given the third chemotherapy with gemcitabine and vinorelbine regimens. His laboratory results in three weeks post-chemotherapy were, 6.4 mg/dl for total bilirubin, 5.87 mg/dl for direct bilirubin, 82 U/L for AST, and 36 U/L for ALT. We also found significant clinical improvement after the third chemotherapy.

Conclusion: The diagnosis is difficult to establish because many other things can also cause obstructive jaundice. Chemotherapy is one therapeutic choice in the management of obstructive jaundice related to Hodgkin's lymphoma.

References

  1. Welaya K, Casulo C. Follicular Lymphoma: Redefining Prognosis, Current Treatment Options, and Unmet Needs. Hematol Oncol Clin North Am. 2019;33(4):627-638. doi:10.1016/j.hoc.2019.03.003
  2. Wong KM, Chang CS, Wu CC, Yin HL. Hodgkin’s lymphoma-related vanishing bile duct syndrome: A case report and literature review. Kaohsiung J Med Sci. 2013;29(11):636-641. doi:10.1016/j.kjms.2013.05.002
  3. Chaudhari D, Khan S, Saleem A, Taylor T, Reddy C, Borthwick T, et al. Obstructive jaundice as an initial manifestation of non-hodgkin lymphoma: Treatment dilemma and high mortality. Case Rep Med. 2013;2013:6-11. doi:http://dx.doi.org/10.1155/2013/259642
  4. Odemis B, Parlak E, Basar O, Yuksel O, Sahin B. Biliary Tract Obstruction Secondary to Malignant Lymphoma: Experience at a Referral Center. Dig Dis Sci 2007:2323-2332. doi:10.1007/s10620-007-9786-4.
  5. Ansell SM. Hodkin lymphoma: diagnosis and treatment. Mayo Clin Proc. 2015;90(11):1574-83.
  6. Dooley JS, Burrough AK, Lok AS, Heathecote EJ. Sherlock’s Disease of the Liver and Biliary System. 12th Ed. Wiley-BlackWel lA John Wiley & Sons, Ltd; 2011.
  7. Piccaluga PP, Agostinelli C, Gazzola A, et al. Pathobiology of Hodgkin Lymphoma. Adv Hematol. 2011;2011:92089. doi:10.1155/2011/920898
  8. Younes A. Handbook of Lymphoma. (Younes A, ed.). Basel: Springer International Publishing; 2016.

How to Cite

Yusuf, F., Innayah, M. R., Maghfirah, D., Azzaki, A., & Riswan, M. (2020). Obstructive jaundice as manifestation of relapsing Hodgkin’s Lymphoma: the success of chemotherapy (case report). Bali Medical Journal, 9(1), 115–120. https://doi.org/10.15562/bmj.v9i1.1706

HTML
1

Total
5

Share