Abstract Details

Title Co-occurrence of multiple sclerosis and Hodgkin lymphoma. Is there a common pathophysiology?

Topic Neuro-oncology

Presentation(s) P12 - Poster Session 12 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-016

Objective To review the diagnosis and treatment of a rare case of synchronous multiple sclerosis (MS) and Hodgkin lymphoma (HL).

Background

MS and HL share common epidemiology, genetics and immunological factors. Both affect immune activation, cell proliferation and lymphocyte-mediated immunity. However, co-occurrence of these two distinct clinical conditions is rare. We present a case of a woman with transverse myelitis fulfilling criteria for MS with synchronous HL.

Design/Methods A 37-year-old woman presented with bilateral leg weakness, numbness and urinary retention. A contrasted brain and spine MRI showed non-specific, non-enhancing white-matter lesions in the brain, and patchy areas of peripheral contrast-enhancement with T2-hyperintensity in the thoracic cord. Treatment with steroid infusion resulted in mild improvement of leg weakness and numbness. Serum was positive for JCV and Epstein-Barr Virus (EBV) IgG antibodies, and negative for EBV IgM. Cerebrospinal fluid (CSF) demonstrated oligoclonal bands (OCB) and increased IgG index. Due to the atypical MRI findings of peripheral nature of thoracic contrast-enhancement, we were concerned for other inflammatory or autoimmune etiologies. A computed tomography of the body revealed a large mediastinal mass and enlarged lymph nodes. A biopsy revealed classic HL. Three-months later, a follow-up MRI brain showed worsening contrast-enhanced lesions. A repeat CSF study revealed normal OCBs and IgG index. CSF was negative for malignant cells, JCV DNA and EBV DNA. To rule out a rare possibility of central nervous system HL, a biopsy of an enhancing brain lesion was obtained, which showed focal gliosis and focal perivascular lymphocytic infiltrates. No malignant cells were observed.

Results She was diagnosed with MS and started doxorubicin, bleomycin, dacarbazine and vinblastine for HL.

Conclusions We report a case of atypical transverse myelitis with HL. Although familial genetic clustering has been described, other potential common risk-factors between MS and HL are EBV infection and immunologic overlap.

Authors/Disclosures
Yugant Khand, MBBS, DiMM PRESENTER	Dr. Khand has nothing to disclose.
Surabhi Ranjan, MD	Dr. Ranjan has nothing to disclose.
Ipshita Garg, MBBS (University of Texas at Tyler)	Dr. Garg has nothing to disclose.
Nestor Galvez-Jimenez, MD (Cleveland Clinic - Florida)	Dr. Galvez-Jimenez has nothing to disclose.

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