We report the case of a 50-year-old male patient with profuse sweating crisis, loss of 10% of body weight and pain in the left knee, without fever, of six months of evolution, who consulted for pain and left enlargement.
Laboratory tests (including LDH) did not show abnormal values and, clinically, he was diagnosed with left trochanter osteomyelitis.
Pelvic X-ray showed a single lytic lesion in the left femoral head confirmed by CT, 99Tc and 67Ga scintigraphy.
Bone biopsy was reported as lymphoproliferative bone involvement with the possibility of being a HL.
A month later, the patient was admitted to our institution where the physical examination revealed an adenopathic mass of 7 cms in diameter in the left axilla and bilateral inguinal lymphadenopathies of months of evolution.
Previous symptoms were interpreted as B symptoms and new laboratory data showed a b2μglobulin of 5 mg/l, LDH 670 and negative serology for HIV and hepatovirus.
Axillary mass biopsy was performed and reported as nodular HL.
The architecture of the ganglion was distorted by fibrous tracts between nodules of lymphocytes, plasma cells, neutrophils, histiocytes and CD-30 + cells, with clear cytoplasm and lobulated nuclei.
There was a focal positivity for CD-15 and EMA and almost all tumor cells were Ki-67 +.
Bone marrow biopsy was reported as fibrosis associated with LH.
CT showed adenopathies in the left axilla, supraclavicular, mediastinum, retroperitoneum, pelvis and groin.
From 24-2-2000 to 29-9-2000, the patient received seven cycles of chemotherapy under ABVD.
In the second cycle, symptoms B and peripheral lymphadenopathies had developed.
At the fourth, the values of ß2μglobulin (1'7 mg/l) and LDH (398) were normal, and at the sixth CT scan only showed no bone marrow biopsy negative LH 67.
Response was consolidated with 3 cycles of chemotherapy in MOPP and RT Gy regimens on the left side on 15-1-2001.
Until today the patient is free of relapse.
QT interval prolongation
BADL (2 weeks): Doxoicin 25 mg/2 + Bleomycin 10 mg/m2 + 6 mg/m2 + Dacarba 375 mg/m2.
COPP (every 4 weeks): Day 1: Cyclophoamide 650 mg/m2 + Vincristine 1'4 mg/m2 + Procarbate 100 mg/m2.
Day 8: Cyclophosphamide 650 mg/m2 + Vincristine 1'4 mg/m2.
Days 1-14: Prednisone 40 mg/m2.
