Hodgkin's disease presenting as “idiopathic” thrombocytopenic purpura

Abstract

Thrombocytopenic purpura of the ITP type is an unusual and poorly documented complication of Hodgkin's disease. In a 5-year period, three patients with Hodgkin's disease presented a clinical picture indistinguishable from classic ITP. Each exhibited marked thrombocytopenic purpura without marrow replacement by tumor or fibrosis, and the number of marrow megakaryocytes was increased. In two, isologous platelet survival was less than 2 hours. Spleens were not palpable and splenectomy resulted in one partial and one complete remission. When thrombocytopenia first appeared, the presence of Hodgkin's disease was often unsuspected, and, in two, the spleen was the only site of clinical involvement. Patients with Hodgkin's disease who present this picture are easily confused with patients who have true ITP, may have an occult recurrence, and are likely to have spleen involvement. This complication appears to be managed best by splenectomy.