Acute cholestatic Hodgkin's lymphoma: an unusual clinical picture

Hodgkin's lymphoma (HL) simulating acute cholestatic hepatitis is a very unusual clinical picture. Massive liver infiltration with conspicuous acute cholestatic symptoms, in fact, suggests more aggressive systemic diseases such as non Hodgkin's lymphomas or acute leukemias. Nevertheless, we observed two cases of mixed cellularity H.L. showing all the symptoms of acute cholestatic hepatitis, without systemic lymph nodes involvement. Diagnosis was achieved by liver biopsy. Hepatic histology showed extensive portal and periportal Hodgkin's infiltrations, loss of periportal liver cells and variable damage to small bile ducts. In both cases bone marrow biopsy showed granulomatous infiltrations. Liver failure appeared to be the most frequent terminal complication of cholestatic H.L. The course of the disease was rapid, and cytostatic therapy scarcely effective. In our opinion, the cholestatic variety of H.L. should be considered in the differential diagnosis of all cases of acute or chronic cholestatic hepatitis, irrespectively of the presence of systemic lymph nodes enlargement.