Hodgkin's disease in homosexual men with generalized lymphadenopathy.

Abstract

The authors present 4 cases of Hodgkin's disease developing in homosexual men with persistent, generalized lymphadenopathy. Laboratory abnormalities associated with the acquired immunodeficiency syndrome (AIDS) and the lymphadenopathy syndrome were present in these patients. In 2 patients, diagnosis of lymphadenopathy syndrome preceded the diagnosis of Hodgkin's disease by 2-3 years; in the other 2, the 2 conditions were noted simultaneously. 2 patients had nodular sclerosing Hodgkin's disease, while the other 2 had mixed cellularity disease. All patients presented with clinical stage III or IV Hodgkin's disease. 2 patients in this group have died: 1 of progressive Hodgkin's disease with evidence of atypical myobacterial infection, and 1 with no evidence of Hodgkin's disease but with AIDS-related infections. The lymphadenopathy syndrome has a presentation similar to that of Hodgkin's disease: lymphadenopathy often accompanied by malaise, fever, night sweats, weight loss, and splenomegaly. When a homosexual man presents with painless adenopathy, with or without constitutional symptoms, the potential diagnosis of Hodgkin's disease or other malignancy should be considered in addition to lymphadenopathy syndrome. Evaluation by lymph node biopsy is advisable. The natural history of Hodgkin's disease in patients at risk for AIDS may be altered to a more aggressive form. Unusual features of Hodgkin's disease observed in this group of patients included presentation with stage IV disease, cutaneous Hodgkin's disease, and bone marrow but no splenic involvement. The effects of the treatment modes used for Hodgkin's disease in homosexual patients should be evaluated for their effect on the risk of AIDS.