Case presentation: Nodular sclerosis classical Hodgkin lymphoma bearing Epstein-Barr virus that developed in an older man

Abstract

A 63-year-old man was admitted to our institution due to loss of 6 kilograms in body weight during the past 2 months. There was no surface lymphadenopathy, and the spleen was palpated 3 finger-breadths below the left costal margin. The hemoglobin level was 11.1 g/dL, white blood cell count 7,100/µL, including 13.0% lymphocytes, and platelet count 121×103/µL. Serum albumin was 3.4 g/dL, C-reactive protein 18.0 mg/dL, erythrocyte sedimentation rate 78 mm/hr, and soluble interleukin-2 receptor 7,107 U/mL. Computed tomography of the body demonstrated an enlarged spleen containing multiple nodules and marked para-aortic lymphadenopathy, as well as supraclavicular lymph node swelling, and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed strong uptake within the enlarged lymph nodes and spleen. A paraaortic lymph node biopsy showed the nodular sclerosis (NS) subtype of classical Hodgkin lymphoma (CHL), and infection with Epstein-Barr virus (EBV) was determined based on the positivity of EBV-encoded small RNAs and polymerase chain reaction amplification of the virus fragment. The patient was diagnosed with CSIII-2B disease of NSCHL and treated with ABVD combination chemotherapy. An 18F-FDG PET scan performed after 2 cycles of ABVD showed resolution of 18F-FDG-avid lymphadenopathy and splenomegaly. The patient finally achieved a complete response after the completion of 6 cycles of ABVD. The pathogenesis of the present case of EBV-positive NSCHL involving an older man may not be identical to that of EBV-negative NSCHL that predominantly develops in younger patients. Despite the presence of risk factors before treatment, an early complete metabolic response determined by 18F-FDG PET suggests long-term progression-free survival.