Hodgkin Lymphoma Presenting as Pel-Ebstein Fever: A Case Report

Abstract

Background: Prolonged fever of more than a year duration can be a symptom of underlying malignancy. This article appreciates the need for diligent history taking and carefully performed clinical examination, which is fundamental to reaching an initial diagnosis.

Case: We report the case of a middle-aged male who presented to us with a fever of more than a year duration. The patient's residence was located in a remote area where the nearby tertiary care center was almost 250 km away. He was empirically treated with antibiotics without any success by local physicians. After more than a year, he reported to us and was diagnosed with Hodgkin lymphoma with a characteristic Pel-Ebstein pattern of fever missed earlier by the local physicians. His fever resolved within 5 days of chemotherapy, and he achieved complete remission.

Conclusion: Meticulous history-taking and clinical examination are essential for reaching a clinical diagnosis. Malignant causes should be considered in the differentials of prolonged fever.

Keywords: Hodgkin lymphoma; Pel–Ebstein fever; malignancy‐related fever.

FIGURE 1

Hematoxylin and Eosin stained sections show effacement of lymph node architecture by lymphoma cells. Numerous bi‐nucleate (arrow—A), mono‐nucleate (blue arrow—B), and multi‐nucleate (arrowhead—B) Reed‐Sternberg cells are seen (400×).

FIGURE 2

Pre (A) and post (B) treatment PET, and corresponding pre (C) and post (D) treatment CT images suggesting a significant response (arrow) to the therapy.