Short report Open Access Association of Hodgkin lymphoma and polymyositis

Background: Coexistence of inflammatory myopathies and malignant conditions is a well-known phenomenon. The contemporary association of polymyositis (PM) and Hodgkin lymphoma (HL) is a very rare phenomenon. Aim: To describe two cases with association of HL and PM and principles of successful therapy. Patients and methods: Case 1. A 34 yr-old man was admitted to the hospital because of severe muscle weakness with recently inability to rise from a bed and a chair and weight loss of 10 kg for the last month. Physical examination revealed bilateral symmetric muscle weakness that affected the proximal shoulder and hip-girdle, with strength assessed at 2-3/5 in hips and 4/5 in shoulders. Laboratory test results included extremely increased muscle enzymes (CPK 10874 U, N<180) and inflammatory markers (CRP 5.46mg/dl, N<0.5, ferritin 4000ng/ml, N<300). Immunological tests were normal including anti Jo-1. FDG-PET/CT revealed enlarged lymph nodes localized deeply in retroperitoneal and periaortal regions. Diagnostic lymph node US guided biopsy showed changes compatible with stage IIIA classical Hodgkin lymphoma of nodular sclerosis type. Pulse therapy with methylprednisolone (1g/day for three consecutive days) was followed by high dose oral prednisolone therapy (1mg/kg) with very graduate tapering (10% of the dose per month). Seven courses of intravenous imminoglobulines (IVIG) (25g/day for 5 days monthly) were combined with 6 cycles of ABVD chemotherapy. Case 2. A 50 yr-old female was hospitalized because of night fever>380C, and 3 kg weight loss last month. Past medical history included polymyositis 8 year duration. Patient was treated with prednisone of 50 mg/day to 5 mg