Digital Ischemia as an Unusual Manifestation of Hodgkin’s Lymphoma

Digital ischemia is associated with atherosclerotic, thromboembolic, or connective tissue diseases. Less often, it can be related to malignancy. Paraneoplastic vascular acrosyndromes (Raynaud’s syndrome, acrocianosis, and acronecrosis) are associated with adenocarcinoma and less frequently with hema...

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Bibliographic Details
Published in:Case reports in hematology 2018-01, Vol.2018 (2018), p.1-4
Main Authors: Di Matteo, Carina, Riva, Eloísa, Peixoto, Adriana, Villano, Fiorella, Díaz, Lilián
Format: Article
Language:English
Subjects:
Amputation
Anticoagulants
Cancer
Case Report
Case reports
Dermatology
Development and progression
Disease
Gangrene
Glycoproteins
Health risk assessment
Hematology
Iloprost
Ischemia
Lupus
Lymphoma
Lymphomas
Patients
Thromboembolism
Tumors
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Summary:Digital ischemia is associated with atherosclerotic, thromboembolic, or connective tissue diseases. Less often, it can be related to malignancy. Paraneoplastic vascular acrosyndromes (Raynaud’s syndrome, acrocianosis, and acronecrosis) are associated with adenocarcinoma and less frequently with hematological malignancies. We report the case of a 45-year-old male, smoker, with a 10-day history of pain, cyanosis, and progressive digital necrosis in both hands. In the previous four months, he noticed painless mass in the right axillary gap, drenching night sweats, and weight loss. Physical examination at admission highlighted necrotic lesions on the distal phalanges of both hands (except the thumbs), enlarged lymph nodes in right axillary, and right supraclavicular gaps. Arteriography of upper limbs demonstrated a distal stop in all bilateral digital arteries. Digital ischemia was interpreted as a paraneoplastic phenomenon after other common etiologies were ruled out. Amputation of three phalanges was required due to necrosis. Biopsy of axillary nodes demonstrated nodular sclerosis classical Hodgkin’s lymphoma (HL). The patient started conventional ABVD protocol (doxorubicin, bleomycin, vinblastine, and dacarbazine). After 6 cycles, he remained asymptomatic and symptoms of digital ischemia were completely resolved. It was concluded that the presence of acral vascular syndromes should alert the physician about the possibility of underlying malignant disease. Prompt investigation and treatment should be rapidly performed to avoid digital sequelae.
ISSN:2090-6560
2090-6579
DOI:10.1155/2018/1980749