The association of autoimmune thrombocytopenia and Hodgkin's disease

Vogt-Koyanagi-Harada syndrome, a rare association of Hodgkin's disease

Vogt-Koyanagi-Harada syndrome (VKHS) is a well-documented clinical entity. We report the case of a 24 year old man who, within 5 months of the diagnosis of VKHS, developed Hodgkin's disease. Like VKHS, the aetiology of Hodgkin's disease is unknown. A viral factor has been suspected in the pathogenesis of both conditions. Similar immunological abnormalities have been described in both, and may be important predisposing factors.

Idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia in Hodgkin's disease

Idiopathic thrombocytopenic purpura (ITP) and Coombs' positive hemolytic anemia (AIHA) were found, respectively, in 5 (1%) and 1 (0.2%) of 492 patients with Hodgkin's disease (HD). 33 cases of ITP associated with HD reported in the literature are reviewed. Of our cases, ITP was coincident with the diagnosis of HD in 1 patient. In another patient ITP preceded the diagnosis of HD by 41 months and in the remaining 3 patients the diagnosis of ITP was established after they had been successfully treated for HD. A herpes zoster infection preceded ITP by 1 month in 1 patient and another had herpes zoster at the time of diagnosis of ITP. AIHA had preceded the diagnosis of HD by 8 months in 1 case. In patients with ITP the prognosis seems to be related only to the status of the underlying HD.

Serial determinations of antiplatelet antibodies in a patient with Hodgkin's disease and autoimmune thrombocytopenia

This case report describes a patient who presented with Stage IV B Hodgkin's disease and autoimmune thrombocytopenia. Prior to the institution of therapy the presence of platelet-associated IgG was documented. When the patient was treated with steroids and chemotherapy, the thrombocytopenia resolved and platelet-associated IgG disappeared. Splenectomy alone did not correct the thrombocytopenia. The literature on Hodgkin's disease and autoimmune thrombocytopenia is reviewed.

Simultaneous Hodgkin's disease in three siblings with identical HLA-genotype

We report 3 cases of Hodgkin's disease (HD) within a family of seven children. All three children had mixed cellularity type in different stages of the disease (IV-B, III-A, and II-A). The diagnosis was made within a one-month interval. HLA typing shows an identical genotype in the 3 HD patients, which was different from the rest of the family. One of the patients developed an idiopathic thrombocytopenic purpura (ITP) with temporary response to prednisone and MOPP-C chemotherapy that subsided after splenectomy. The HLA identity, in addition to the simultaneous onset of the HD, suggests a combination of both genetic and environmental factors in the pathogenesis of this disease.

Idiopathic thrombocytopenic purpura and Hodgkin's disease: report of two cases and a review of the literature

Twenty-five patients from the literature and two additional patients with Hodgkin's disease and idiopathic thrombocytopenic purpura (ITP) are reviewed. In 22 patients the ITP occurred after the Hodgkin's disease was treated. In nine of these patients, the Hodgkin's disease. In one patient, ITP preceded Hodgkin's disease by one year. Seven of 26 patients achieved complete remission of the ITP with prednisone. In each of these patients the Hodgkin's disease was in complete remission, and each had a previous splenectomy. Seven of 14 patients achieved complete remission of the ITP after splenectomy. Four of these patients had active Hodgkin's disease. Of the 27 patients, 14 were in remission of the Hodgkin's disease at the time of ITP. To date, relapse of the Hodgkin's disease had occurred in only one patient. Lymphadenopathy in five of these patients proved to be benign hyperplasia on biopsy. In addition to the association with Hodgkin's disease, review of ITP cases at Upstate Medical Center and a recent report in the literature indicate that there may be a general association between ITP and malignancy.

Idiopathic thrombocytopenic purpura occurring in Hodgkin disease after splenectomy: report of two cases and review of the literature

The occurrence of idiopathic thrombocytopenic purpura (ITP) in Hodgkin disease is uncommon. Even more unusual is the development of ITP in Hodgkin disease following splenectomy. This report describes two patients with Hodgkin disease who developed severe ITP with negative platelet antibody studies very soon after splenectomy (20 days in one and three months in the other). A review of the literature of 21 other patients with well-documented ITP and Hodgkin disease indicated that ITP occurring in Hodgkin disease may be more severe and refractory to therapy than ITP unassociated with Hodgkin. Nodular sclerosis or mixed cellularity histologic types of Hodgkin disease were present in all but one of the patients with ITP and Hodgkin disease, and males constituted 65% of cases. There appeared to be no correlation between the onset of ITP and activity of Hodgkin disease. Of five splenectomized patients with Hodgkin disease who developed ITP and were treated with immunosuppressive drugs for thrombocytopenia, three had an excellent response and two had a good response, suggesting that the combination of corticosteroids and immunosuppressive drugs may be indicated at the outset in patients with Hodgkin disease who develop ITP following splenectomy.

A syndrome resembling idiopathic thrombocytopenic purpura in 10 patients with diverse forms of cancer

Ten patients with diverse forms of carcinoma (six patients) and of cancer in the lymphoid system (four patients) presented with or subsequently had a syndrome resembling idiopathic thrombocytopenic purpura (ITP). These patients were older than patients who had ITP alone. ITP was coincident with a diagnosis of cancer (three patients), preceded a diagnosis of cancer (three patients) or followed a diagnosis of cancer (four patients). No patients responded to steroid therapy permanently. Therefore, the course of our patients was fairly typical of ITP in the adult. Since we found nine patients with cancer in a survey of 52 consecutive patients with ITP in the adult population admitted to one hospital, this diagnosis may be missed with some frequency; the development of thrombocytopenia being attributed to other causes.

Idiopathic thrombocytopenic purpura in Hodgkin's disease: a rare occurrence of no prognostic significance

Six patients with Hodgkin's disease who developed idiopathic thrombocytopenic purpura (ITP) are presented. In contrast to prior cases reported in the literature, none of these patients developed recurrent Hodgkin's disease at the time of or subsequent to their thrombocytopenia, with follow-up data available up to 10 years. ITP does not necessarily imply recurrent or active malignancy.

Platelet satellitism and phagocytosis by neutrophils: association with antiplatelet antibodies and lymphoma

Satellitism and phagocytosis of platelets by neutrophils in EDTA anticoagulated blood have been considered in vitro phenomena without clinical significance. We observed these in a patient with acute, severe thrombocytopenic purpura who subsequently proved to have malignant lymphoma. Wide oscillations in the platelet count were noted and recurrent, severe gastrointestinal bleeding occurred even when the platelet count was normal. Platelet function was abnormal as shown by decreased platelet adhesion to glass beads, absence of a secondary wave of aggregation in response to ADP and eqinephrine, and no aggregation with collagen. Suspension of control platelets in the patient's plasma induced similar aggregation defects in the control platelets. Combination chemotherapy resulted in regression of lymphadenopathy, but platelet abnormalities and bleeding persisted. Platelet satellitism and phagocytosis by neutrophils seen on peripheral blood films may be associated with true thrombocytopenia, abnormal platelet function and bleeding with an underlying systemic disease.

Idiopathic thrombocytopenic purpura in lymphoma

Five patients with idiopathic thrombocytopenic purpura (ITP) associated with malignant lymphoma are presented, and twelve other cases reported in the literature are reviewed. Thirteen patients (76%) had Hodgkin's disease; two had diffuse histiocytic, one, diffuse mixed lymphoma. Idiopathic thrombocytopenic purpura presented as the sole clinical manifestation of initial or recurrent lymphoma in 10 of 15 cases (67%). The spleen was not palpable even in patients who showed involvement with lymphoma at splenectomy. Three patients were asplenic at the onset of idiopathic thrombocytopenic purpura. Successful therapy of the thrombocytopenia correlated with effective control of the underlying lymphoma. Splenectomy gave favorable results in 9 of 10 cases (90%) and uncovered occult lymphoma in five patients. Chemotherapeutic drugs were successful in seven of 12 trials (58%) and only when the underlying disease was also controlled. The overall prognosis was related to the status of the lymphoma and was not altered by the occurrence of the idiopathic thrombocytopenic purpura.