A 36-year-old healthy woman with no past medical history presented to the emergency department with generalized purpura and petechiae. She also reported 4 month long history of painless right-sided neck swelling, drenching night sweat and unintentional significant weight loss. Her examination revealed bilateral cervical lymphadenopathy and splenomegaly. Labs showed platelets of 5 K/UL with large platelets on peripheral smear. CT scan showed cervical, mediastinal and bilateral supraclavicular lymphadenopathy with splenomegaly and multiple hypodense splenic masses. Lymph node biopsy confirmed nodular sclerosis classic Hodgkin lymphoma. Bone marrow biopsy, flow cytometry and chromosomal analysis were negative. A diagnosis of Immune Thrombocytopenic Purpura (ITP) was made.
Patient initially responded to high dose intravenous dexamethasone and immunoglobulin. She was discharged with platelet count of 56 K/UL. However, 4 days later, patient relapsed with severe ITP and again a platelet count of 5 K/UL. This time she had a poor response to conventional ITP treatment and only improved after chemotherapy was started.
Immune Thrombocytopenic Purpura (ITP) is a blood disorder characterized by autoantibodies destroying platelets and interfering with their production. ITP can be primary or secondary to a coexisting condition. Although the association between ITP and lymphoproliferative diseases has been observed and documented, it’s uncommon to be associated with Hodgkin’s disease (HD) as we report.
Our case represents a seldom reported association between HD and ITP, even with fewer cases reported of ITP being the initial presentation of HD. Severe ITP is a life threatening disease, when secondary, identifying and treating the underlying cause is crucial.