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SYSTEMIC LUPUS ERYTHEMATOSUS AND HODGKIN'S DISEASE

In October 1988, while bathing, a 32-year-old woman discovered a mass under her left clavicle. On clinical examination the mass was 3 x 5 cm in size filling the left subclavicular area in addition to bilateral, axillary adenopathy, 4 cm in diameter. The patient had no fever and had noted no change in her general condition. Neither her liver nor her spleen was enlarged. A discrete erythema on the face and the palms of the hands was noted. This patient's previous history of illness included pulmonary arterial hypertension for the past 3 years treated with nifedipine and Raynaud's syndrome since the previous winter. A thoracic scan showed a left subclavicular mass located at the level of the anterior soft parts of the thoracic cage. It was composed of several confluent nodes with an overall width of 10 cm and located behind the pectoral muscle. A biopsy showed changes of Hodgkin's disease, grade 3, and was of mixed cellularity. The Sternberg's cells were marked by anti-CD 15 and anti-CD 30 monoclonal antibodies. The erythrocyte sedimentation rate was elevated at 44 mm/hour and there was a polyclonal hypergammaglobulinemia of 3 g/dL. A bone marrow biopsy was normal but the lymphogram showed hypertrophic, ghost-like lumbar lymph nodes. Given the absence of general signs, a grade IMA Hodgkin's disease was diagnosed. Due to the facial and palmar erythema, the pulmonary arterial hypertension, and the recent Raynaud's phenomenon, immunological tests were also done. Homogeneous antinuclear antibodies at a titer of 1:500, double-stranded anti-DNA antibodies at 61 units (normal <25 units by the Farr assay), the presence of anti-SSA antibodies, and a decrease of the complement fraction C4 (12 mg/dL) were noted, clearly suggesting lupus erythematosus. Chemotherapy with cyclophosphamide, vincristine, procarbazine, and prednisolone was begun. The first treatment was uneventful, but when prednisolone was stopped 5 days later, pain In the hand and wrist joints with substantial swelling developed indicating tenosynovitis. When treatment with systemic corticosteroids, 60 mg/day, was resumed, these articular signs disappeared rapidly. Chemotherapy was continued. Currently, 16 months later, the Hodgkin's disease is in complete remission. As for the lupus, pain remains in a few joints. The immunological tests show the persistence of antinuclear antibodies (titer 1/250, homogenous) and anti-SSA antibodies, but the anti-DNA antibodies are absent, while prednisolone, 20 mg/day, is administered to the patient each day.