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Renal Hodgkin's disease

A 44-year-old woman was admitted to hospital because of malaise, fever and night sweats of 3 months duration; menorrhagia occurred a week before admission. Physical examination showed only moderate splenomegaly. Blood examination showed pancytopenia, disseminated intravascular coagulation and increased lactate dehydrogenase. Liver and renal function tests were normal. A computerized tomography (CT) scan of the thorax, abdomen and pelvis showed multiple soft tissue attenuation masses in both kidneys (left; arrows). Renal lesions were initially thought to be of infectious origin: the patient was treated with broad-spectrum antibiotics but the symptoms persisted. Bone marrow biopsy and uterine curettage were diagnostic of Hodgkin’s disease of the mixed cellularity type. The patient was then treated with the ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) protocol with prompt symptomatic recovery. An abdominal CT scan after three cycles of chemotherapy showed complete resolution of renal lesions (right). Renal involvement in Hodgkin’s disease is a very uncommon event, documented in < 1% of patients at diagnosis; however, such a possibility should be taken into account in the differential diagnosis of a patient with fever of unknown origin and multiple renal lesions.