Abstract
A two-view chest radiograph showed bilateral hilar lymphadenopathy, a normal heart silhouette, and no pleural effusions or focal pulmonary consolidations. Abdominal ultrasound and computed tomography (CT) with radiocontrast revealed lymphadenopathy throughout his chest and abdomen. These findings were confirmed by whole-body positron emission tomography (PET) /CT, which showed mul t ip le fludeoxyglucose (FDG)-avid lesions above and below the diaphragm and a hypermetabolic lesion in the femoral neck. Nodular sclerosis-type classical Hodgkin’s lymphoma (HL) was diagnosed by excisional lymph node biopsy. A bone marrow biopsy was positive for HL, and he was diagnosed with stage IV HL with B symptoms (night sweats and fevers). Serum and tissue in situ hybridization testing for the EpsteinBarr virus (EBV) was negative, ruling out any association of the virus with his lymphoma. He was treated with four cycles of BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). There was no sign of persistent disease at the end of chemotherapy. He remains on tacrolimus for his previous diagnosis of nephrotic syndrome (NS), which has remained in remission.
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