Digital gangrene as an unusual paraneoplastic manifestation of hodgkins lymphoma\u2014a rare case report

Swaroopa Deme,Venkateswar Rao P,Bhaskar Kakarla,Nageswara Rao M,Raju Ysn

doi:10.1186/s43162-021-00076-7

Swaroopa Deme, Venkateswar Rao P + Show 3 more

Open Access

https://doi.org/10.1186/s43162-021-00076-7

Copy DOI

Abstract

BackgroundHodgkin’s lymphoma presenting with digital ischemia and gangrene is a rare manifestation. Paraneoplastic manifestations are rare in Hodgkin’s lymphoma but can occur in the form of paraneoplastic cerebellar degeneration (PCD) and dermatomyositis/polymyositis. This case report adds an exceptional presentation of Hodgkin's lymphoma as digital ischemia and gangrene.Case presentationWe report a case of a 60-year-old male patient who presented with fever, cough, shortness of breath, the pain in the right middle finger. On examination bluish-black discoloration of the right middle finger, left middle finger, ring finger, and generalized lymphadenopathy was noted. On further evaluation, he was found to have anemia, eosinophilia, and severe thrombocytopenia with a normal coagulation profile and negative rheumatological workup. Arterial Doppler of both upper limbs showed the normal study. He was diagnosed to have Hodgkin’s lymphoma on the lymph node and bone marrow biopsy. He was started on chemotherapy with partial improvement in symptoms and was lost to follow-up after 2 cycles.ConclusionsDigital ischemia can be a rare paraneoplastic manifestation of Hodgkin’s lymphoma.

Highlights

Hodgkin’s lymphoma presenting with digital ischemia and gangrene is a rare manifestation
Digital ischemia with gangrene of one or several fingertips as a paraneoplastic manifestation is common with adenocarcinoma and is rare with other malignancies
In the absence of evidence of rheumatological, cardiovascular, occupational, arteriosclerotic, and autoimmune diseases, an acute occurrence of digital ischemia and gangrene should suggest a possibility of paraneoplastic syndrome and the need for a thorough search of malignancy [1]

Summary

Background

Digital ischemia with gangrene of one or several fingertips as a paraneoplastic manifestation is common with adenocarcinoma and is rare with other malignancies. Peripheral pulses, blackish discoloration of fingertips of right and left middle fingers, and left ring finger (Fig. 1). He had multiple nontender, rubbery consistent lymph nodal swellings in bilateral cervical, axillary, and inguinal regions with the largest inguinal lymph node measuring 3 × 3 cm. Differential diagnosis of digital gangrene considered was Buerger’s disease as the patient being a smoker, vasculitides, connective tissue disorders with vasculitis, antiphospholipid antibody syndrome, and malignancy with paraneoplastic manifestation/hypercoagulable state. A diagnosis of Hodgkin’s lymphoma-mixed cellularity type, stage IV with paraneoplastic digital ischemia/

Discussion

Findings

Conclusions

Competing interests Nil