Clinically unsuspected Hodgkin disease presenting initially in the bone marrow of patients infected with the human immunodeficiency virus

Abstract

Hodgkin disease (HD) in patients infected with the human immunodeficiency virus (HIV) is an aggressive neoplasm that often exhibits high stage and extranodal involvement at the time of presentation. Because of the propensity of HIV-associated HD to involve the bone marrow early in the course of the neoplasm, bone marrow examination may often represent the initial source for the diagnosis. In most cases, however, there is a clinical suspicion of HD before bone marrow examination. Three cases are presented in which HD was not clinically suspected and the initial diagnosis of the neoplasm was suggested by atypical lymphohistiocytic lesions identified on routine bone marrow examination, later to be confirmed by lymph node biopsy. In none of the cases was HD clinically suspected before bone marrow examination; in two cases, fever was the only clue that the patients may have HD. It was found on bone marrow biopsy that all three patients had lymphohistiocytic aggregates with large atypical mononuclear cells suggestive but not diagnostic of HD. Bone marrow examination may provide the initial evidence of HD in HIV-infected patients, even when there is little or no clinical indication of the neoplasm.