%0 Journal Article
%T Autoimmune Hemolytic Anemia and Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Rare Association
%A G¨¦raldine Salmeron
%A Thierry Jo Molina
%A Claire Fieschi
%A Anne-Marie Zagdanski
%A Pauline Brice
%A David Sibon
%J Case Reports in Hematology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/567289
%X Autoimmune hemolytic anemia (AIHA) has been associated with chronic lymphocytic leukemia, non-Hodgkin lymphoma, and classical Hodgkin lymphoma, but to the best of our knowledge, the association of AIHA and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) has not been reported previously. A 20-year-old woman presented with conjunctival jaundice, fever, asthenia, and hemoglobin 9.2£¿g/dL revealing IgG-mediated warm antibody AIHA. Computed tomography (CT) scan and positron-emission tomography (PET) scan showed mediastinal and axillary lymph nodes with increased [18F]-fluorodeoxyglucose uptake. A mediastinal lymph node was biopsied during mediastinoscopy, and NLPHL was diagnosed by an expert hematopathologist. The hemoglobin level declined to 4.6£¿g/dL. The treatment consisted of four 28-day cycles of R-ABVD (rituximab 375£¿mg/m2 IV, adriamycin 25£¿mg/m2 IV, bleomycin 10£¿mg/m2 IV, vinblastine 6£¿mg/m2 IV, and dacarbazine 375£¿mg/m2 IV, each on days 1 and 15). Prednisone was progressively tapered over 10 weeks. After the first chemotherapy cycle, the hemoglobin level rose to 12£¿g/dL. After the four cycles, PET and CT scans showed complete remission (CR). At the last followup (4 years), AIHA and NLPHL were in sustained CR. 1. Introduction The most common diseases underlying warm antibody autoimmune hemolytic anemia (AIHA) are lymphoproliferative disorders and autoimmune diseases. Among the former, AIHA has been associated with chronic lymphocytic leukemia, non-Hodgkin lymphoma, and classical Hodgkin lymphoma. We describe here the rare association of AIHA and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). Combining immunotherapy and chemotherapy achieved rapid and sustained AIHA and NLPHL complete remission. 2. Case Presentation A 20-year-old woman consulted in 2008 for conjunctival jaundice, fever, and asthenia. Her medical history was unremarkable and she was not taking any current treatment. Physical examination was normal. Full blood-cell count revealed hemoglobin 9.2£¿g/dL, mean corpuscular volume 90£¿fL, reticulocyte count 242 ¡Á 109/L, WBC count 6.7 ¡Á 109/L, neutrophil count 3.8 ¡Á 109/L, lymphocyte count 1.9 ¡Á 109/L, and platelets 221 ¡Á 109/L. Haptoglobin was below 0.06£¿g/L, serum lactate dehydrogenase (LDH) was elevated (688£¿U/L; upper limit of normal, 470£¿U/L), and unconjugated bilirubin was high (72£¿¦Ìmol/L). A blood smear showed mild red-cell anisocytosis, polychromasia, and spherocytosis, with normal WBC and platelet morphologies. The direct antiglobulin test (DAT) was strongly positive for red cell-bound immunoglobulin G (IgG) and negative
%U http://www.hindawi.com/journals/crihem/2013/567289/