Case Report

We report a case of a 42-year-old male with complaints of profuse daytime sweating for six months. He said that “sweat pours out of my body.” These sweating episodes came in spurts and he had an unusual ability to predict them. He felt this condition was socially embarrassing and described these episodes as “hot flashes”. He denied any headaches, dizziness, vertigo or paresthesia. There was no cough, hemoptysis, wheezing or shortness of breath. Review of systems was negative for chest pain or palpitations. His appetite was good and there was no heartburn. No dysuria or increase in frequency was reported. There were no joint pains, joint swellings, skin rashes or lesions. He denied any feeling of excessive cold. His past medical history was remarkable for undescended testicle which was brought down at 10 years age. He had a thoracotomy 15 years ago for pleural effusion that he assumes was due to motor vehicle accident that he was involved in two years prior to that. He had a history of alcoholic pancreatitis. He was not on any medications and reported no drug allergies. There was no family history of malignancy. He worked as a marketing director. He drank alcohol occasionally, did not smoke and used no recreational drugs. On physical examination he looked healthy, alert and oriented to time, place and person. Head and neck examination showed no jaundice or pallor. There was no nasal congestion. Throat examination was normal with moist and pink tongue. Neck showed no swelling, abnormal pulsations, jugular venous distension or bruit and there was no lymphadenopathy. Chest showed no deformity and there were bilateral breath sounds with no wheezes or rhonchi. Heart sounds were normal with no murmurs, rubs or gallops. Abdomen was soft, nontender with no palpable hepatosplenomegaly. There was no limb edema or clubbing. Neurological examination was normal with no motor, sensory or cranial nerve deficits. Musculoskeletal examination showed normal range of motion for joints with no joint swelling. He had normal blood count, chem.-9 and thyroid studies.

This patient presented two months later with progressive symptoms of day and night time sweating, generalized weakness and fatigue. He had lost 40 lbs in this period. He denied and abdominal pain, nausea or vomiting. Examination of head and neck revealed prominent 1-1.5 cm cervical and supraclavicular lymphadenopathy with rubbery, firm and mobile lymph nodes. He also had 2 cm size inguinal and axillary lymphadenopathy. Lymphoma was suspected and a lymph node biopsy showed Nodular sclerosis Hodgkin's disease. His staging CAT scan showed extensive chest, abdominal and pelvic lymphadenopathy and hepatosplenomegaly. Pt was diagnosed with Hodgkin's stage III b and started on ABVP treatment with remarkable improvement.

Figure 1

Figure 1 shows a Reed - Sternberg cell with a binucleated cell with classical owl eye appearance. In the background reactive lymphocytes and eosinophils ( H & E stain 100 X )

Discussion

The major lymphatic structures involved in Hodgkin's disease are groups and chains of lymph nodes, the spleen and the thymus gland. The digestive system is also an important lymphoid organ that has collections of lymphoid tissue known as Waldeyer's ring in the oropharynx, Peyer's patches in the ileum and lymphoid nodules in the appendix. Hodgkin's disease can involve almost any organ or tissue, especially the liver, bone marrow, and spleen, in addition to the lymph nodes.

Figure 2

Table 1: Stage Grouping

Each stage is subdivided into “A” and “B” categories, “B” for those with defined systemic symptoms and “A” for those without. The B designation is given to those patients with:

1. Unexplained loss of more than 10% of body weight in 6 months before diagnosis;

2. Unexplained fever with temperatures above 38°C; and

3. Drenching night sweats.

4. Pruritis alone does not qualify for B classification, nor does a short febrile illness associated with an infection.