Unexplained hypotension in Hodgkin's disease

A 51-year-old black male with progressive polymyositis presented to our hospital with respiratory failure. Hemodynamic monitoring revealed tachycardia, arterial hypotension, a high cardiac index, and low systemic vascular resistance. Evaluation for common etiologies of this hemodynamic pattern was unrewarding. He was found to have Hodgkin's disease of the bone marrow. Aggressive combination chemotherapy led to normalization of heart rate and arterial pressure. It is postulated that Hodgkin's disease through some undetermined mechanism can cause a hyperdynamic circulatory pattern. This hemodynamic state reversed with suppression of the tumor.