ISSN 2326-7283
African Journal of Internal Medicine ISSN: 2326-7283 Vol. 9 (10), pp. 001-006, October, 2021. © International Scholars Journals
Case Report
Hodgkin's disease and bone marrow compression following a diagnostic delay in the Internal Medicine and Medical Oncology Unit at the National Teaching Hospital Center (NTHC)-Hubert Koutoukou Maga (HKM) of Cotonou: a case report and review of the literature
Azon Kouanou Angèle1, Agbodande Kouessi Anthelme1, Murhula Katabana Delphin1,2, Assogba Houénoudé Mickaël Arnaud1, Missiho Mahoutin Semassa Ghislain1, Sokadjo Yves Morel1., Gbewedo Noé1, Ahouissoussi Ibiyele Cornelly3, Baglo Tatiana4, Zannou Djimon Marcel1, Houngbe Fabien1
1Internal medicine and medical oncology unit of the (NTHC)-HKM of Cotonou, Republic of Benin. Corresponding author: Angèle AZON KOUANOU, 06BP1782, E.mail: [email protected]
2Internal Medicine Unit of the University Clinics of Bukavu, Official University of Bukavu, Democratic Republic of Congo.
3Anatomopathological laboratory Adéchina (Ex Dubois) of Cotonou in the Republic of Benin
4Hematology and blood diseases department at the CNHU-HKM of Cotonou.
Accepted 05 October, 2021
Abstract
Introduction: Hodgkin's disease is a rare disease of the lymphoid tissue that occurs mainly in young adults. Its localization in the bone marrow is rare and can lead to severe functional disability. We are reporting in this work the case of a young boy of 18-year-old who was followed in the department. Observation: 18-year-old patient admitted to the department for exploration of febrile adenopathies (PDA), context of weight loss. The onset was reported to be one year prior to admission. The diagnosis of tuberculosis was suspected and treated for 4 months without success, in front of evocative signs with a notion of contagion. This situation was associated with moderate asthenia, intermittent fever without cough, or night sweats. The occurrence of a progressive paresis of the right pelvic limb, three days before admission, associated with low spinal pain and hyperesthesia of the pelvic limbs motivated her hospitalization. General conditions altered with a WHO performance index of 2. Temperature was 37°8C, HR 90bpm, Blod Pression (BP): 120/85mmHg, Respiratory Rate (RR) 20cpm, oxygen saturation (SpO2): 98% on room air. Physical examination: presence of bilateral superficial cervical, axillary and inguinal PDAs, painless, mobile, of variable size. Paraplegia was noted with 3/5 motor strength in the left pelvic limb and 2/5 in the right pelvic limb. Low spinal pain of the burning type 9/10 according to VAS. Biology showed a major inflammatory syndrome. On imaging, the thoracoabdominopelvic CT scan showed hepatosplenomegaly and multiple deep retroperitoneal adenopathies with soft tissue infiltration. Spinal cord MRI revealed multiple spondylitis, an extensive intraductal and epidural tissue process at T12-L1 and L2-L3, and an anterior epidural infiltration opposite L2 responsible for spinal cord compression. Pathology of the cervical lymph node revealed the presence of Reed Stenberg cells with CD30+ expression on immunohistochemistry. The patient was put on chemotherapy and the evolution at 3 months was slowly favorable with progressive functional recovery. Conclusion: Spinal cord compression is a rare complication of Hodgkin lymphoma. It often occurs at an advanced stage of the disease. The evolution can be favorable if treated early and appropriately.
Keywords: Lymphoma, Hodgkin, diagnostic delay, bone marrow compression.