Liver involvement is common in advanced stages of Hodgkin's disease. However, only a small percentage of patients with Hodgkin's disease develops jaundice due to several causes. Vanishing bile duct syndrome secondary to Hodgkin's disease is a rare cause of cholestasis in these patients. Only 20, cases, to our knowledge, have been reported so far in adults. We report a case of Hodgkin's disease presenting with obstructive jaundice without detectable liver involvement. Liver biopsies revealed intrahepatic cholestasis and ductopenia. Although the patient was given chemotherapy, he died of sepsis and disseminated intravascular coagulation after 24 weeks of admission to hospital.
BagleyC.M.Jr., ThomasL.B., JohnsonR.E., ChretienP.B., de VitaVTJr.: Diagnosis of liver involvement by lymphoma: results in 96 consecutive peritoneoscopies.Cancer, 31: 840–847, 1973.
MartinK.R., MooreT.J., WrightA.R.: Obstructive jaundice secondary to primary involvement with Hodgkin's disease.Am J Gastroenterol, 87: 1194–1195, 1992.
6.
LiebermanD.A.: Intrahepatic cholestasis due to Hodgkin's disease: an elusive diagnosis.J Clin Gastroenterol, 8: 304–307, 1986.
7.
HubscherS.G., LumleyM.A., EliasG.A.: Vanishing bile duct syndrome: a possible mechanism for intrahepatic cholestasis in Hodgkin's lymphoma.Hepatology, 17: 70–77, 1993.
8.
SherlockS.: The syndrome of disappearing intrahepatic bile ducts.Lancet, 2: 493–496, 1987.
9.
AlamI., FerrellL.D., BassN.M.: Vanishing bile duct syndrome temporally associated with ibuprofen use.Am J Gastroenterol, 91: 1626–1630, 1996.
10.
De GaloscyC., HorsmansY., RahierJ., GeubelA.P.: Vanishing bile duct syndrome occurring after carbamazepine administration: a second case report.J Clin Gastroenterol, 19: 269–271, 1994.
11.
MoradpourD., AltorferJ., Flury RgremingerP., MeyenbergerC., JostR., SchmidM.: Chlorpromazine-induced vanishing bile duct syndrome leading to biliary cirrhosis.Hepatology, 20: 1437–1441, 1994.
12.
AltraifI., LilyL., WanlessI.R., HeatcoteJ.: Cholestatic liver disease with ductopenia (vanishing bile duct syndrome) after administration of clindamycin and trimethoprim-sulfamethoxazole.Am J Gastroenterol, 89: 1230–1234, 1994.
13.
HuntC.M., WashingtonK.: Tetracycline-induced bile duct paucity and prolonged cholestasis.Gastroenterology, 107: 1844–1847, 1994.
14.
LeblancA., HadchouelM., JehanP., OdievreM., AlagilleD.: Obstructive jaundice in children with histiocytosis X.Gastroenterology, 80: 134–139, 1981.
15.
WatersonJ., PriestJ.R.: Jaundice as a paraneoplastic phenomenon in a T-cell lymphoma.Gastroenterology, 97: 1319–1322, 1989.
16.
LudwigJ., WiesnerR.H., LaRussoN.F.: Idiopathic adulthood ductopenia: a cause of chronic cholestatic liver disease and biliary cirrhosis.J Hepatol, 7: 193–199, 1988.
17.
CrosbieO.M., CrownJ.P., NolanN.P.M., MurrayR., HegartyJ.E.: Resolution of paraneoplastic bile duct paucity following successful treatment of Hodgkin's disease.Hepatology, 26: 5–8, 1997.
LiangpunsakulS., KwoP., KoukoulisG.K.: Hodgkin's disease presenting as cholestatic hepatitis with prominent ductal injury.Eur J Gastroenterol Hepatol, 14: 323–327, 2002.
20.
KomurcuS., OzetA., AltundagM.K., ArpaciF., OzturkB., CelasunB., TezcanY.: Vanishing bile duct syndrome occurring after high-dose chemotherapy and autologous peripheral stem cell transplantation in a patient with Hodgkin's disease.Ann Hematol, 81: 57–58, 2002.
21.
RipollC., CarreteroL., SabinP., AlvarezE., MarrupeD., BanaresR.: Idiopathic cholestasis associated with progressive ductopenia in two patients with Hodgkin's disease.Gastroenterol Hepatol, 25: 313–315, 2002.
22.
AlloryY., MetreauJ., ZafraniE.: Paraneoplastic vanishing bile duct syndrome in a case of Hodgkin's disease.Ann Pathol, 20: 52–55, 2000.
23.
De MedeirosB.C., LacerdaM.A., TellesJ.E., da SilvaJ.A., de MedeirosC.R.: Cholestasis secondary to Hodgkin's disease: report of 2 cases of vanishing bile duct syndrome.Haematologica, 83: 1038–1040, 1998.
24.
O'BrienC.B., ShieldsD.S., SaulS.H., ReddyK.R.: Drug-induced vanishing bile duct syndrome: response to ursodiol.Am J Gastroenterol, 91: 1456–1457, 1996.
