Unusual cause of cholestatic jaundice in a patient with AIDS

A 61-year-old man with AIDS on chronic highly active antiretroviral treatment (HAART) presented with lethargy and jaundice and was found to have abnormal liver function tests (LFTs). Investigations including viral/autoimmune markers and imaging were unrevealing, except for positive Epstein-Barr viru...

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Bibliographic Details
Published in:BMJ case reports 2013-08, Vol.2013, p.bcr2013200113
Main Authors: Kim, Su Bin, Shrivastava, Makardhwaj Sarvadaman, Anampa, Jesus M, Strakhan, Marianna
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Acquired Immunodeficiency Syndrome - complications
Acquired Immunodeficiency Syndrome - drug therapy
AIDS
Alanine Transaminase - blood
Antigens
Antiretroviral Therapy, Highly Active
Aspartate Aminotransferases - blood
Black
Bone marrow
Chemotherapy
Cysts
Gallbladder
Gallbladder diseases
Hepatitis
HIV
Hodgkin Disease - complications
Human immunodeficiency virus
Humans
Jaundice, Obstructive - etiology
Liver
Liver Neoplasms - complications
Lymphatic system
Lymphoma
Male
Middle Aged
Mortality
Pathology
Patients
Phosphatase
Rare Disease
Sepsis
USA/Canada
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Summary:A 61-year-old man with AIDS on chronic highly active antiretroviral treatment (HAART) presented with lethargy and jaundice and was found to have abnormal liver function tests (LFTs). Investigations including viral/autoimmune markers and imaging were unrevealing, except for positive Epstein-Barr virus. HAART was held, however, transaminases and total bilirubin continued to rise. The liver biopsy revealed classical Hodgkin's lymphoma (HL). HL presenting only with liver findings without lymphadenopathy is rare. Extreme cases can lead to fulminant liver failure. The bone marrow biopsy and dramatic elevation in serum ferritin were consistent with haemophagocytic lymphohistiocytosis. Finding a chemotherapy regimen was challenging given abnormal LFTs and HAART interactions. Initial chemotherapy regimen has successfully decreased LFTs; however, it was limited by pancytopenia. The patient's regimen was changed, however second regimen was complicated by neuropathy. LFTs improved and the patient was able to receive the standard care chemotherapy for HL with significant clinical, laboratory and radiological improvement.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-200113