Abstract
An 81-year-old male presented to the emergency room with a 3-month history of progressive shortness of breath, productive cough with white sputum, and generalized weakness with 10-pound weight loss in 2 months. On presentation, the patient was afebrile, with blood pressure of 93/55 mm Hg and oxy-hemoglobin saturation of 92% on 2 liters of oxygen via nasal cannula. Complete blood count with differential was significant for white count of 12 400/mL. Brain natriuretic peptide level was 454 ng/mL. Postero-anterior chest radiograph showed multiple round opacities in the lung fields. Computed tomography scan of the chest confirmed multiple round densities in both the lung fields along with mild mediastinal lymphadenopathy. Core needle biopsy was performed. Immunohistochemical stains were positive for CD30 and CD15 in a population of large atypical cells amid a background of CD3-positive nonneoplastic cells. These results were in support of the diagnosis of classical Hodgkin’s lymphoma of the lung with histological appearance confirming nodular sclerosis type. The patient was started on chemotherapy but was readmitted in 20 days for acute respiratory distress and suffered cardiac arrest and subsequently died. This case highlights the fact that although primary pulmonary Hodgkin’s lymphoma of the lung is a rare entity, it should be thought of as a differential while evaluating lung masses. In these cases, definite diagnosis can only be made by biopsy and histology. Early commencement of chemotherapy and regular follow-up with oncology is essential.
Highlights
Primary pulmonary Hodgkin’s lymphoma (PPHL) is exceedingly rare with fewer than 100 cases reported worldwide
We report a rare case of an 81-year-old patient with PPHL
An 81-year-old male with a history of hypertension, atrial fibrillation, congestive heart failure (CHF) with ejection fraction of 45% presented to the emergency room with progressive shortness of breath for 3 months
Summary
Primary pulmonary Hodgkin’s lymphoma (PPHL) is exceedingly rare with fewer than 100 cases reported worldwide. We report a rare case of an 81-year-old patient with PPHL. An 81-year-old male with a history of hypertension, atrial fibrillation, congestive heart failure (CHF) with ejection fraction of 45% presented to the emergency room with progressive shortness of breath for 3 months. He complained of cough, productive of white sputum with generalized weakness and 10-lb weight loss over the past 2 months. Stains for CD20 and CD1A were negative These results combined with the histological findings support the diagnosis of classical Hodgkin’s lymphoma of the lung with histological appearance confirming nodular sclerosis type. The patient subsequently suffered from a cardiac arrest and could not be resuscitated and expired
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