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Refractory Classical Hodgkin Lymphoma Presenting with Atypical Cutaneous Involvement and Diagnosis of ZZ Phenotype Alpha-1 Antitrypsin Deficiency.
[hodgkin lymphoma, classical]
Cutaneous
Hodgkin
lymphoma
is
a
rare
condition
.
Specific
neoplastic
involvement
can
be
primary
(
confined
to
the
skin
)
or
secondary
to
systemic
involvement
(
metastatic
)
.
Cutaneous
involvement
by
HL
usually
occurs
late
in
the
course
and
is
associated
with
poor
prognosis
;
however
in
some
cases
it
can
exhibit
indolent
behavior
.
Skin
involvement
with
nonspecific
cutaneous
findings
may
represent
a
paraneoplastic
syndrome
.
We
describe
a
case
of
46
-
year
-old
white
male
patient
presented
with
rash
and
lymphadenopathy
which
led
to
the
diagnosis
of
stage
IVE
mixed
cellularity
classical
Hodgkin
lymphoma
with
skin
involvement
.
His
disease
was
refractory
to
multiple
lines
of
chemotherapy
including
(
1
)
AVD
(
doxorubicin
/
bleomycin
/
dacarbazine
)
,
(
2
)
brentuximab
,
and
(
3
)
bendamustine
,
he
later
achieved
complete
remission
with
(
4
)
GCD
(
gemcitabine
/
carboplatin
/
dexamethasone
)
salvage
regimen
.
Bleomycin
was
not
given
secondary
to
poor
pulmonary
function
tests
.
His
treatment
was
complicated
after
AVD
with
multiple
pneumothoraces
which
unmasked
the
diagnosis
of
ZZ
phenotype
alpha-
1
antitrypsin
(
ATT
)
deficiency
.
Simultaneous
existence
of
Hodgkin
lymphoma
and
ATT
is
rarely
reported
.