Treating a Simultaneous Presentation of Multiple Myeloma and Hodgkin’s Lymphoma

Case Report

Ann Hematol Oncol. 2018; 5(4): 1202.

Treating a Simultaneous Presentation of Multiple Myeloma and Hodgkin’s Lymphoma

Shervani S1*, Durham C1, Williams C2, Surapaneni R,2 and Mirkes C1

1Department of Internal Medicine, Texas A&M Health Science Center College of Medicine and Baylor Scott and White Memorial Hospital

2Division of Hematology and Oncology, Texas A&M Health Science Center College of Medicine and Baylor Scott and White Memorial Hospital

*Corresponding author: Shervani S, Department of Internal Medicine, Texas A&M Health Science Center College of Medicine and Baylor Scott and White Memorial Hospital, 2401 S. 31st Street, Temple, TX 76508, USA

Received: April 16, 2018; Accepted: May 07, 2018; Published: May 21, 2018

Abstract

There are few published case reports of the simultaneous presentation of Multiple Myeloma and Hodgkin’s Lymphoma (HL). Several case reports document sequential diagnosis of HL after MM, especially after therapy including autologous stem cell transplant (ASCT) for MM. However our case is rare as it describes the symptomatic presentation of MM and HL diagnosed concurrently – before any therapies were initiated. We present a case of a 66-year-old woman who presented to the emergency department for hip pain and was found to have multiple lytic lesions and periaortic lymphadenopathy, leading to a diagnosis of both MM and HL. Accurately diagnosing both malignancies had significant impact on the selection of initial therapy, though choosing an effective treatment regimen for both malignancies is a challenge as there are no clear guidelines to follow in this rare situation. This case highlights the importance of investigating the etiology of pathologic lymphadenopathy in a patient with MM, and also proposes a successful treatment regimen for a patient diagnosed with simultaneous MM and HL.

Keywords: Multiple myeloma; Hodgkin’s lymphoma; Lymphadenopathy; Treatment

Introduction

Hodgkin’s Lymphoma (HL) is a B cell neoplasm arising from germinal center or post germinal center B cells. Multiple Myeloma is a neoplastic proliferation of plasma cells (derived from B cells) that produce a monoclonal immunoglobin. Several case reports describe sequential diagnosis of HL after MM especially after autologous stem cell transplant for MM. However, the presentation of HL and MM diagnosed concurrently, prior to initiating any therapy, is far more rare and presents a unique diagnostic and treatment challenge, as illustrated by this case. MM does not present with lymphadenopathy, which led to further workup and diagnosis of a second malignancy in this patient. Treatment included ABVD therapy, dexamethasone, and zolendronic acid injections concurrently, which were then followed by bortezomib and dexamethasone.

Case Presentation

A 66-year-old woman with a history of diabetes mellitus type II and hypertension presented to the emergency department for right hip pain and 20 pound weight loss. The patient had tenderness to palpation over the right hip and back. There was no palpable lymphadenopathy. She was found to have multiple lytic osseous lesions involving the proximal right femur (Figure 1), L4 vertebral body, and left seventh rib on computerized tomography. Periaortic (Figure 1), porta hepatic, and aortocaval lymphadenopathy was also noted. She underwent cephalomedullary nailing of the right femur for a pathologic fracture.