PREGNANT LADY WITH UNDIAGNOSED HODGKIN'S DISEASE PRESENTING AS SECONDARY SCLEROSING CHOLANGITIS

Taif Khattak, Syed Hashim Ali Shah, Waqas Khan, Syed Shahmeer Raza, Uzair Ahmad, Farhan Ullah

Abstract


Cholestatic jaundice as a paraneoplastic feature of secondary sclerosing cholangitis is rare in Hodgkin’s lymphoma. A 25 years old lady, 34 weeks primigravida was referred from the Emergency Department to the Medical Unit Khyber Teaching Hospital-MTI, Peshawar with four weeks of fever, progressive jaundice, pruritus, night sweats and weight loss. LFTs showed cholestatic picture, ERCP showed scanty intrahepatic giving beading and autumn tree appearance typical of sclerosing cholangitis. CBD was normal. Doppler U/S of hepatic and portal vein reported normal. She was started on steroids, ursodeoxycholic acid and antibiotics 3rd generation cephalosporins to which she did not respond well. This prompted a Liver biopsy which showed Hodgkin’s disease having mixed cellularity. She was shifted to specialized oncology unit for further management where she died of irreversible liver damage. This is a rare case of secondary sclerosing cholangitis in Hodgkin’s lymphoma of liver and the first case reported to our Hospital.

 

Cholestatic jaundice as a paraneoplastic feature of secondary sclerosing cholangitis is rare in Hodgkin’s lymphoma. A 25 years old lady, 34 weeks primigravida was referred from the Emergency Department to the Medical Unit Khyber Teaching Hospital-MTI, Peshawar with four weeks of fever, progressive jaundice, pruritus, night sweats and weight loss. LFTs showed cholestatic picture, ERCP showed scanty intrahepatic giving beading and autumn tree appearance typical of sclerosing cholangitis. CBD was normal. Doppler U/S of hepatic and portal vein reported normal. She was started on steroids, ursodeoxycholic acid and antibiotics 3rd generation cephalosporins to which she did not respond well. This prompted a Liver biopsy which showed Hodgkin’s disease having mixed cellularity. She was shifted to specialized oncology unit for further management where she died of irreversible liver damage. This is a rare case of secondary sclerosing cholangitis in Hodgkin’s lymphoma of liver and the first case reported to our Hospital.

Keywords: Paraneoplastic; Hodgkin’s lymphoma; Jaundice; Cholangitis


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References


Abdalian R, Heathcote EJ. Sclerosing cholangitis: A focus on secondary causes. Hepatology 2006;44(5):1063–74.

Krishnamurthy GT, Krishnamurthy S. Nuclear Hepatology: A textbook of Hepatobiliary diseases. Berlin: Springer; 2000.

Kariv R, Konikoff F. Sclerosing cholangitis--primary, secondary and more. Isr Med Assoc J 2002;4(12):1141–2.

Jaffe ES. Malignant lymphomas: Pathology of hepatic involvement. Semin liver Dis 1987;7(3):257–68.

Abedi SH, Ghassami M, Molaei M, Mohsenifar Z, Mohammad Alizadeh AH. Secondary Sclerosing Cholangitis and Hodgkin’s lymphoma 2015;8:83–7.

Hubscher S, Buckels JA, Elias E, McMaster P, Neuberger JM. Reversible vanishing bile duct syndrome after liver transplantation: Report of 6 cases. Transplant Proc 1991;23(1 Pt 2):1415–6.

LaRusso N, Shneider BL, Black D, Gores GJ, James SP, Doo E, et al. Primary sclerosing cholangitis: Summary of a workshop. Hepatology 2006;44(3):746–64.


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