Nasir Khokhar, Yasmin Shamsuddin, Muzaffar Lateef Gill, Saleem Siddiqui, Shaukat A Bangash.
Hodgkin`s disease presenting as cholestatic jaundice.
Rawal Med J May ;28(2):75-6.

Patient is 45 years old lady who presented with history of fever and jaundice for two months. The fever was high grade and continuous and it was associated with chills and sweating. Her previous work up has been negative for malaria, typhoid and brucella. She has been treated with anti-malarials and antibiotics without any improvement. Examination revealed an ill-looking lady with a of 1010F, pulse 100/min. She was jaundiced. Liver was palpable three finger breadths below right costle margin and the spleen was also enlarged. No ascites or a mass was palpable. Rest of the examination was unremarkable. Laboratory investigations showed a hemoglobin 10.5g/dl, hematocrit 30.4%, MCV 84.3, a white blood cells count was 12,200/cmm, and platelet count was 195, 000/cmm. Electrolytes were normal. Total bilirubin was 6.3mg/dl, direct bilirubin 4.42mg/dl, ALT 27 iu (normal <31), AST 25 iu (normal <31), and an alkaline phosphatase of 567 iu (normal <120). Protime (PT) was 18.2 seconds. Hepatitis B surface antigen, anti-HCV, anti-nuclear antibody (ANA) and chest x-rays were normal. Malarial parasite and brucella antibodies were negative. An ultrasound of the abdomen showed hepatosplenomegaly and focal lesions in the liver and spleen and a small amount of fluid in the pelvis. A CT scan of the abdomen confirmed these findings. An exploratory laparotomy revealed lymph nodes in the porta hepatis which were biopsied. Histopathology report showed Hodgkin’s disease of mixed cellularity type. Patient was started on chemotherapy and showed response.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals -