First Reported Case of Disease: Peliosis Hepatis as Cardinal Symptom of Hodgkin's Lymphoma

• Published in: The oncologist (Dayton, Ohio) Vol. 14; no. 11; pp. 1088 - 1094
• Main Authors: Kleger, Alexander, Bommer, Martin, Kunze, Markus, Klaus, Jochen, Leithaeuser, Frank, Wegener, Martin, Adler, Guido, Dikopoulos, Nektarios
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01-11-2009
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bleomycin - administration & dosage; Cyclophosphamide - administration & dosage; Etoposide - administration & dosage; Female; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - drug therapy; Hodgkin's disease; Humans; Liver disease; Lymphoma; Minilaparoscopy; Peliosis hepatis; Peliosis Hepatis - diagnostic imaging; Peliosis Hepatis - drug therapy; Prednisone - administration & dosage; Procarbazine - administration & dosage; Tomography, X-Ray Computed; Treatment Outcome; Vincristine - administration & dosage
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2009-0215

We present the case of a 25‐year‐old woman with a history of weakness, weight loss, anemia, and elevated liver enzymes. Outpatient diagnostic evaluation, including abdominal ultrasound and endoscopies, revealed no conclusive explanation for the clinical picture and the patient was admitted to our clinic. Because of the hepatosplenomegaly together with the elevated liver enzymes, one of our differential diagnoses was that of liver disease. To clarify this, we performed a minilaparoscopy, which showed multiple diffuse distributed spots of livid color without clear margins distributed all over both liver lobes. A biopsy taken from these areas revealed the diagnosis of peliosis hepatis with irregular and diffusely enlarged hepatic sinusoids with an irregular structure. Peliosis hepatis is associated with numerous infectious and neoplastic diseases, but also occurs as a result of toxic liver damage. Further evaluation of our patient with an x‐ray and a computed tomography (CT) scan revealed a mediastinal mass and a CT‐guided biopsy showed classical Hodgkin's lymphoma. After completing further screening, a definitive diagnosis of Hodgkin's lymphoma stage II/N/B (Ann‐Arbor) was established and chemotherapy according to the German Hodgkin's study group protocol with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (the BEACOPP regimen) was initiated. After the first chemotherapy cycle, the patient's symptoms and laboratory values improved rapidly. Taken together, we present the case of a patient with peliosis hepatis as an uncommon manifestation of Hodgkin's lymphoma. Despite an extensive literature search, we could not find any case of peliosis hepatis associated with a de novo diagnosis of classical Hodgkin's disease.
Presented is a case of a patient with peliosis hepatis as an uncommon manifestation of Hodgkin's lymphoma. Clinicians should always be aware of the fact that elevated liver enzymes could also be a sign of an underlying systemic extrahepatic disease.