A case of Hodgkin's disease presenting boneache associated with the ingestion of alcohol as the initial disease manifestation

Abstract

This patient, a 26-year-old man, originally presented on July, 1992 with the lumboischial pain and the left coxalgia radiating to the left lower leg after the ingestion of alcohol. Eight months later the pain increased in severity and became almost continuous, with occasional radiation into the left lower extremity. Intermittent night sweats and fever occured at the same time. Two weeks before admission he entered another hospital. X-ray studies of the bones disclosed the osteolytic lesion in the left acetabulum. He was referred to our hospital for investigation of the abnormal bone lesion and systemic symptoms on March 25, 1993. The diagnosis of Hodgkin's disease (mixed cellularity) was made by biopsy taken from the lytic lesion in the acetabulum. Staging work-up revealed an additional lesions in the iliac and para-aortic lymph nodes, upper mediastinum, the left 3th rib, and lymph nodes located in the left neck and axilla. He received 6 cycles of chemotherapy with CHOP regimen and was given a course of local X-irradiation (40Gy) to the involveved bone lesion. Two months later the disease relapsed, treatment was recommenced using intensive chemotherapy consisting of cyclophosphamide, nimustine, and etoposide followed by hematopoietic stem-cell support with autologous peripheral-blood progenitor cells. He has been well without evidence of recurrent disease for three years since the last chemotherapy.We report a rare case of HD presenting osteocope associated with the ingestion of alcohol as the initial disease manifestation. A review of the literature is also presented.