Nonbacterial or marantic endocarditis was noted in 19% of asymptomatic patients with HD or NHL.135 The thrombotic rate was also increased in these patients, suggesting a hypercoagulable state.

Hypercalcemia occurs in 0.3-0.4% of patients with lymphoma.136 While it is more common with adult T-cell leukemia/lymphoma, it can also be seen with HD and B-cell NHL. A variety of mechanisms, including parathyroid hormone-related peptide, Il-6, TNF,137 prostaglandins, and elevated levels of vitamin D3138 have been postulated as being etio-logic. Therapy is similar to that used for other forms of hypercalcemia.

Another rare disorder is recurrent angioedema of the face, larynx, extremities, and occasionally scrotum due to acquired C1 esterase-inhibitor deficiency.139 It is usually associated with indolent B-cell lymphoprolifer-ative disorders, commonly with lymphoplasmacytoid differentiation and paraprotein secretion, and can precede the diagnosis of lymphoma by several years.140 Laboratory testing reveals low C1 esterase-inhibitor activity, low C4 and C3, and low C1q levels.

Rare cases of cholestatic jaundice without evidence of intrahepatic disease may occur in NHL and HD.141142 The so-called "vanishing duct" syndrome, characterized by extrahepatic obstruction without intrahepatic ductal dilatation, eventually culminates in hepatic failure and carries a poor prognosis.143144 There are several case reports of vasculitis associated with lymphoproliferative disease, including Wegener's granulomatosis and Churg-Strauss disease, temporal arteritis, and cryoglobulinemia.

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