ABSTRACT
BACKGROUND: Hodgkin Lymphoma (HL) is rarely associated with autoimmune hemolytic anemia. We report here two cases of such association: Case 1: 57 years old man who presented with tiredness and pallor. Physical examination revealed multiple left cervical lymph nodes. Blood count showed regenerative macrocytic anemia with signs of hemolysis. Auto immune hemolytic anemia was confirmed by a positive direct antiglobulin test for IgG and C3d; lymph node biopsy revealed lymphocytic rich HL. Case 2: a 50 year old man being treated for HL for few months presented to the emergency room for dyspnea and pallor. Blood count showed regenerative macrocytic anemia with positive direct antiglobulin test for IgG and C3d confirming the diagnosis of AIHA as a relapse of the lymphoma. These two cases show that clinicians should be aware of such association revealing the diagnosis or the relapse of the lymphoma to distinguish it from anemia of chronic disease.
Subject(s)
Humans , Male , Middle Aged , Hodgkin Disease , Anemia, Hemolytic, Autoimmune , Coombs Test , Lymphoma , Chronic Disease , Dyspnea , Lymph Nodes , Immunoglobulin G , Anemia, MacrocyticABSTRACT
Iterative hypoglycaemic comas in type 1 diabetic patients are a serious problem which may be caused by many factors like educational errors, unawareness of hypoglycaemia and also adrenal insufficiency and diabetic nephropathy while factitious hypoglycaemia is the major diagnostic pitfall. We report an unusual case of a 35-year-old man, who presents a type 1 diabetes for the past 23 years, and who had unexplained hypoglycaemic comas for the past four months even after decreasing his insulin doses. The investigation revealed factitious insulin injections but also the presence of adrenal insufficiency Graves' disease and diabetic nephropathy without renal failure. Psychiatric evaluation showed a depressive state induced by diabetic complications and hyperthyroidism. This case report emphasizes the fact that organic and factitious causes of hypoglycaemia may be present in the same patient that is referred for type 1 diabetic hypoglycaemia