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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 48-Year-Old Woman With Remote Hodgkin Disease and Bilateral Pleural Effusions

Christopher J. Ryerson, MD; Andrew Churg, MD; Pearce G. Wilcox, MD
Author and Funding Information

Affiliations: From the Departments of Pathology (Dr. Churg) and Medicine (Drs. Wilcox and Ryerson), University of British Columbia, Vancouver, BC, Canada.

Correspondence to: Christopher J. Ryerson, MD, University of British Columbia, Respiratory Medicine, 8B, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6; e-mail: cryerson@interchange.ubc.ca


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(3):934-937. doi:10.1378/chest.09-0005
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Extract

A 48-year-old nonsmoking woman presented with 3 months of progressive dyspnea. In the preceding 6 months, the patient had bilateral pulmonary emboli with deep vein thromboses (DVTs) of the superior vena cava, azygous vein, and inferior vena cava. Her DVTs progressed despite anticoagulation with warfarin, and subsequently with dalteparin. Her medical history was significant for stage 3b nodular sclerosing Hodgkin lymphoma diagnosed at the age of 20 years. She was treated with four cycles of mechlorethamine, vincristine, procarbazine, and prednisone, with mantle and whole-abdomen radiation. She had recurrence 6 years later, which was successfully treated with two cycles of mechlorethamine, vinblastine, procarbazine, and prednisone, followed by high-dose carmustine, cyclophosphamide, and etoposide. This was followed by an autologous bone marrow transplant. She had been in remission since that time. Further history revealed cervical cancer at the age of 38 years, hypothyroidism on replacement, and transfusion-related hepatitis C acquired during the treatment of her lymphoma with no cirrhosis or portal hypertension. She had no significant occupational or environmental exposures, including no known exposure to asbestos.

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