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Cutaneous vasculitis as an initiating paraneoplastic symptom in Hodgkin lymphoma

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Abstract

Skin vasculitis may be associated with infections and autoimmune diseases. Furthermore, vasculitis may appear as a paraneoplastic symptom. A 19-year-old male patient was examined with swollen joints and papules presented on lower extremitis. Laboratory results showed high erythrocyte sedimentation ratio, positive C reactive protein, increased number of leukocytes and high circulating immune complex level. Histopatology of skin biopsy specimen proved vasculitis. ANCA was not present. No other changes could be observed besides skin involvement. Symptoms disappeared on 0.5-mg/bwkg methylprednisolon therapy. Few weeks later, enlarged cervical lymph nodes developed besides fever and weight loss. Biopsy indicated the presence of mixed cell type Hodgkin lymphoma. Appropriate examinations revealed clinical stage III/B with favorable prognosis (IPS = 2). After eight cycles of ABVD therapy complete remission was achieved as confirmed by FDG-PET. As a consequence of the treatment of Hodgkin lymphoma, vasculitis also disappeared. The present case report calls to attention the importance of careful examinations to exclude other diseases, especially malignancies that may remain at the background of cutaneous vasculitis. Treatment of the primary disease also results in the improvement of secondary skin vasculitis.

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References

  1. Andras Cs, Csiki Z, Pony A, Illes A, Danko K (2006) Paraneoplastic rheumatic syndromes. Rheumatol Int 26:376–382

    Article  PubMed  Google Scholar 

  2. Chakravarty E, Genovese MC (2003) Rheumatic syndromes associated with malignancy. Curr Opin Rheumatol 15:35–43

    Article  PubMed  Google Scholar 

  3. Fam AG (2000) Paraneoplastic rheumatic syndromes. Baillieres Best Pract Res Clin Rheumatol 14:515–533

    Article  PubMed  CAS  Google Scholar 

  4. Ponge T, Boutoille D, Moreau A, Germaud P, Dabouis G, Baranger T, Barrier J (1998) Systemic vasculitis in patients with small-cell neuroendocrine bronchial cancer. Eur Respir J 12:1228–1229

    Article  PubMed  CAS  Google Scholar 

  5. Schwarzer AC, Schriber L (1991) Rheumatic manifestations of neoplasia. Curr Opin Rheumatol 3:145–154

    Article  PubMed  CAS  Google Scholar 

  6. Watz H, Hammerl P, Matter C, Degen M, Heinmann F, Heitmann H, Ermert L, Wagner TO (2004) Bronchioloalveolar carcinoma of lung associated with a highly positive pANCA-titer and clinical signs of microscopic polyangitis. Pneumologie 58:493–498

    Article  PubMed  CAS  Google Scholar 

  7. Ehrenfeld M, Abu-Shakara M, Buskila D, Shoenfeld Y (2001) The dual association between lymphoma and autoimmunity. Blood Cells Mol Dis 27:750–756

    Article  PubMed  CAS  Google Scholar 

  8. Hamidou MA, El Kouri D, Audrain M, Grolleau JY (2001) Systemic antineutrophil cytoplasmatic antibody vasculitis associated with lymphoid neoplasia. Ann Rheumatol Dis 60:293–259

    Article  CAS  Google Scholar 

  9. Paydas S, Zorludemir S, Sahin B (2000) Vasculitis and leukemia. Leuk Lymphoma 40:105–112

    Article  PubMed  CAS  Google Scholar 

  10. Séne D, Saadoun D, Limal N, Piette JC, Cacoub P (2007) Update in Hepatitis C virus associated extrahepatic manifestations. Rev Med Interne 28(6):388–393

    Article  PubMed  Google Scholar 

  11. Cabuk M, Inanir I, Turkgodan P, Ceylan C, Degirmenci M, Turel A, Ozdemir E (2004) Cyclic lymphocytic vasculitis associated with chronic lymphocytic leukemia. Leuk Lymphoma 45:811–813

    Article  PubMed  Google Scholar 

  12. Bernatsky S, Bovin JF, Joseph L, Gordon C, Urowitz M, Gladman D, Ginzler E, Fortin P, Bae SC, Barr S, Isenberg D, Rahman A, Petri M, Alarcón G, Aranow C, Dooley MA, Rajan R, Sénécal JL, Zummer M, Manzi S, Edworthy S, Ramsey-Goldman R, Clarke A (2005) An international cohort study of cancer in systemic lupus erythematosus. Arthritis Rheum 52:1481–1490

    Article  PubMed  CAS  Google Scholar 

  13. Voulgarelis M, Moutsopoulos HM (2001) Malignant lymphoma in primary Sjögren’s syndrome. Isr Med Assoc J 3:761–766

    PubMed  CAS  Google Scholar 

  14. Varoczy L, Gergely L, Zeher M, Szegedi Gy, Illes A (2002) Malignant lymphoma-associated autoimmune diseases- a descriptive epidemiological study. Rheumatol Int 22:233–237

    Article  PubMed  Google Scholar 

  15. Ponyi A, Constatin T, Garami M, Andras C, Tallai B, Vancsa A, Gergely L, Danko K (2005) Cancer-associated myositis: clinical features and prognostic signs. Ann NY Acad Sci 1051:64–71

    Article  PubMed  Google Scholar 

  16. Jaing TH, Hsueh C, Chiu CH, Shih IH, Chna CK, Hung IJ (2002) Cutaneus lymphocytic vasculitis of acute lymphoblastic leukemia. J Pediatr Hematol Oncol 24:555–557

    Article  PubMed  Google Scholar 

  17. Warrington KJ, Scheithauer BW, Mischet CJ (2003) Acute myeloid leukemia associated with necrotizing temporal arteritis. J Rheumatol 30:846–848

    PubMed  Google Scholar 

  18. Wilson D, McCluggage WG, Wright GD (2002) Urticarial vasculitis: a paraneoplastic presentation of B-cell non-Hodgkin’s lymphoma. Rheumatol 41:476–477

    Article  CAS  Google Scholar 

  19. Leshem E, Davodovitz Y, Meltzer E, Fefer P, Ofek E, Sidi Y (2006) Fulminant vasculitis: a rare fatal complication of lymphoma. Acta Haematol 115:117–122

    Article  PubMed  Google Scholar 

  20. Cardinali C, Santinin S, di Leo A, Giannini A, Giovanni S (2006) Generalized B-cell non Hodgkin lymphoma in association with leukocytoclastic vasculitis and disseminated intravascular coagulation. Dermatol Online J 12:15–23

    PubMed  Google Scholar 

  21. Calvo-Romero JM (2003) Diffuse large B cell lymphoma in patient with hypocomplementemic urticarial vasculitis. J Postgrad Med 49:252–253

    PubMed  CAS  Google Scholar 

  22. Simon Z, Tarr T, Ress Z, Gergely L, Kiss E, Illes A (2007) Successful Rituximab-CHOP treatment of systemic lupus erythematosus associated with diffuse large B-cell non-Hodgkin lymphoma. Rheumatol Int. doi:10.1007/s00296-007-0400-z

  23. Rubenstein M, Duvic M (2006) Cutaneus manifestations of Hodgkin’s disease. Int J Derm 45:251–256

    Article  PubMed  Google Scholar 

  24. Ng JP, Murphy J, Chalmers EM, Hogg RB, Cumming RL, Peebles S (1988) Henoch–Schönlein purpura and Hodgkin’s disease. Postgrad Med J 64:881–882

    PubMed  CAS  Google Scholar 

  25. Blanco P, Dinisi R, Rispal P, Deminiere C, Pellegrin JL, Leng B, Aparicio M (1999) Honoch-Schönlein purpura associated with segmental and focal proliferative glomerulonephritis in a patient with Hodgkin’s disease. Nephrol Dial Transplant 14:179–180

    Article  PubMed  CAS  Google Scholar 

  26. Blanco P, Neau D, Pellegrin JL, Leng B (1999) Erythema nodosum and cutaneus vasculitis revealing Hodgkin’s disease. Apropos of 2 case reports. Rev Med Interne 20:160–163

    PubMed  CAS  Google Scholar 

  27. Homenda W, Hellmann A (2000) Hodgkin’s disease with systemic vasculitis and Lambert–Eaton myasthenic syndrome-case report. Wiad Leuk 53:574–578

    CAS  Google Scholar 

  28. Keresztes K, Miltenyi Zs, Bessenyei B, Beck Z, Szollosi Z, Nemes Z, Olah E, Illes A (2006) Association between the Epsten–Barr virus and Hodgkin’s lymphoma in North-Eastern part of Hungary: effects on therapy and survival. Acta Haematol 116:101–107

    Article  PubMed  Google Scholar 

  29. Bai M, Skyrlas A, Agnantis NJ, Kamina S, Tsanou E, Grepi C, Galani V, Kanavaros P (2004) Diffuse large B-cell lymphomas with germinal center B-cell like differentiation immunophenotypic profile are associated with high apoptotic index, high expression of the proapoptotic proteins bax, bak and bid and low expression of the antiapoptotic protein bcl-xl. Mod Pathol 17:847–856

    Article  PubMed  CAS  Google Scholar 

  30. Syringos KN, Salgami E, Karayiannakis AJ, Katirtzoglou N, Sekara E, Roussou P (2004) Prognostic significance of soluble adhesion molecules in Hodgkin’s disease. Anticancer Res 24:1243–1247

    Google Scholar 

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Authors and Affiliations

  1. 3rd Department of Institute for Internal Medicine, University of Debrecen Medical and Health Science Center, Móricz Zs. krt. 22., 4032, Debrecen, Hungary

    Zsófia Simon, Tünde Tarr, Gabriella Szűcs & Árpád Illés

  2. Institute of Pathology, University of Debrecen, Medical and Health Science Center, Nagyerdei krt. 98., 4032, Debrecen, Hungary

    László Tóth

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  1. Zsófia Simon
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  2. Tünde Tarr
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  3. László Tóth
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  4. Gabriella Szűcs
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  5. Árpád Illés
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Correspondence to Zsófia Simon.

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Simon, Z., Tarr, T., Tóth, L. et al. Cutaneous vasculitis as an initiating paraneoplastic symptom in Hodgkin lymphoma. Rheumatol Int 28, 719–723 (2008). https://doi.org/10.1007/s00296-007-0513-4

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  • DOI: https://doi.org/10.1007/s00296-007-0513-4

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