Hypotension associated with advanced hodgkin lymphoma

Abstract

Hypotension is an extremely rare manifestation of Hodgkin lymphoma. We report the case of a patient who presented with new onset hypotension and was diagnosed with urosepsis and septic shock requiring pressor support for maintaining his blood pressure. computed tomography (CT) scan of abdomen showed liver lesions, which were new on comparison with a CT abdomen done 3 weeks back. Biopsy of the liver lesions and subsequently a bone marrow biopsy showed large atypical Reed-Sternberg cells, positive for CD15 and CD 30 and negative for CD45, CD3 and CD20 on immuno-histochemical staining, hence establishing the diagnosis of Hodgkin lymphoma. The mechanism involved in Hodgkin lymphoma causing hypotension remains anecdotal, but since it is mostly seen in patients with advanced Hodgkin lymphoma, it is hypothetically related to a complex interaction between cytokines and mediators of vasodilatation. Here we review relevant literature pertaining to presentation and pathogenesis of this elusive and rare association.

Keywords: Hodgkin lymphoma; hypotension; liver metastasis.

Figure 1.

Ill defined lesions seen in the liver.

Figure 2.

Extensive Lymphocytic, histiocytic infiltrates with abnormal large cells and positive staining for CD 15 and CD 30 (From left to right).

Figure 3.

Graphs of the blood pressure and temperature curves of this patient during first and second admission (combined).