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Relapsed Hodgkin's disease presenting as a right knee swelling
C F Leong1, P Y Soo, S A Fadilah
1Clinical Haematology & Transplantation Services, Institute Kanser MAKNA-HUKM, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur.
The Medical Journal of Malaysia
|October 15, 2003
Summary
This case highlights an unusual relapse of Hodgkin's disease presenting as significant knee swelling and osteolytic lesions. Despite salvage chemotherapy, the patient defaulted treatment again, underscoring challenges in managing relapsed Hodgkin's disease.
Area of Science:
- Oncology
- Hematology
- Medical Case Reports
Background:
- Hodgkin's disease is a cancer of the lymphatic system.
- Initial treatment involved combination chemotherapy (Chlorambucil, Vincristine, Procarbazine, Prednisolone).
- Patient defaulted after two chemotherapy courses.
Observation:
- One year post-default, patient presented with severe right knee swelling (15x20 cm), pain, anorexia, weight loss, fever, night sweats, and pruritus.
- Radiographs showed osteolytic lesions in the distal femur and proximal tibia/fibula with periosteal reaction and soft tissue swelling.
- Biopsy confirmed Hodgkin's disease recurrence in the right femur.
Findings:
- Salvage chemotherapy (Chlorambucil, Vincristine, Procarbazine, Prednisolone, Doxorubicin, Bleomycin, Vinblastine) led to significant symptom reduction.
- Patient again defaulted after two courses of salvage therapy.
- The relapse presented unusually with prominent skeletal involvement.
Implications:
- This case underscores the importance of treatment adherence in managing Hodgkin's disease.
- Unusual presentations of relapsed Hodgkin's disease, such as extensive bone involvement, require careful diagnosis and management.
- Defaulting treatment can lead to disease progression and treatment challenges.