Diffuse 18F-fluorodeoxyglucose accumulation in the bone marrow of a patient with haemophagocytic lymphohistiocytosis due to Hodgkin lymphoma

Description

A 53-year-old man was referred to our hospital due to malaise with intermittent high fever. Thoracoabdominal CT scan revealed abdominal lymphadenopathy with splenomegaly. Hepatic disorder (aspartate transaminase 47 IU/L; alanine transaminase 53 IU/L), peripheral blood cytopaenia (red blood cell count 370x10⁴/μL; haemoglobin 11.0 g/dL; haematocrit 32.9%; platelet count 7.9x10⁴/μL), hypertriglyceridaemia (184 mg/dL), hyperferritinaemia (4111 ng/mL) and an increased serum soluble interleukin-2 receptor level (4450 U/mL) were observed. Bone marrow (BM) aspiration showed erythrocyte phagocytosis by macrophages (figure 1A). However, no atypical cells were detected. Additional BM trephine biopsy was not performed. Pathological examination of a laparoscopic lymph node biopsy revealed Reed-Sternberg cells (figure 1B), and atypical cells were positive for CD30 but not for CD3, CD20 or CD79a indicating nodular sclerosis Hodgkin lymphoma (HL). A diagnosis of lymphoma-associated haemophagocytic lymphohistiocytosis (LA-HLH) was established. ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) performed for the staging showed splenic and multiple abdominal lymph node...

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