Paraneoplastic syndromes

Classical HL is associated with the overexpression of a variety of cytokines and their receptors on Hodgkin's or Reed-Sternberg cells and in the surrounding inflammatory infiltrate. These cytokines, including interleukin 2 (IL-2), IL-5, IL-6, IL-7, IL-9, IL-10, IL-13, transforming growth factor p (TGFp), and lympho-toxin A (LT-A), may be responsible for the systemic symptoms of HL and for the rare paraneoplastic syndromes associated with HL. Nephrotic syndrome, idiopathic thrombocytopenia purpura, autoimmune hemolytic anemia, and cerebellar degeneration/ataxia have all been reported in patients with HL.14-18 Typically, nephrotic syndrome or neurologic symptoms precede a diagnosis of HL or herald a relapse, although occasionally high-dose steroids used to treat many of these syndromes may contribute to a delay in diagnosis.14,16 Idiopathic thrombocytopenia has been described in patients preceding the diagnosis of HL, at the time of relapse, and in patients in clinical remis-

sion for HL.1718 Life-threatening complications of HL, including fulminant hepatic failure and lactic acidosis, have also been described,1920 although these situations are quite rare.

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