Hodgkin's disease presenting with progressive liver failure

We report an unusual case of a 70-year-old man with a diagnosis of Hodgkin's disease, who presented with fever and liver dysfunction. A few cervical lymph nodes, less than 1 cm in diameter were palpable, but other lymph nodes were not detected even by CT scan. Blood cell counts showed thrombocytopenia (platelet counts 6.8 x 10(4)/microliter), and some values for liver enzymes were out of the normal range (AST 56 U/l, ALT 87 U/l, LDH 347 U/l, ALP 1,529 U/l, and gamma-GTP 190 U/l). Abdominal CT scan showed diffuse enlargement of the liver and spleen. Endoscopic retrograde biliary cholangiopancreatography was performed because of progressive jaundice, but no abnormality was found in the biliary tract. A few granulomas were observed in bone marrow clot specimens, but tumor cells were not detected. A diagnosis of Hodgkin's disease was established by a cervical lymph node biopsy. Chemotherapy was immediately instituted, and both the jaundice and fever improved dramatically. Because cervical lymph nodes were not detected at one month after the onset and liver dysfunction appeared before cytopenia, it is suggested that the site of the primary lesion in this case was the liver.