[Hodgkin's disease presenting as an hepatic disease. Report of two cases (author's transl)].
During the course of Hodgkin's disease there is a low incidence of clinical manifestations of liver involvement: less than 15% of the patients present jaundice at some time during the evolution of their disease. The initial manifestation of Hodgkin's disease as an hepatic illness is a rare event. Two such cases are herein reported. The first patient was a 68 year-old male with a febrile illness of one month duration who 15 days before admission presented painless jaundice, dark urine, and discolored stools. The clinical work-up pointed to the possible existence of an extrahepatic cholestasis. At laparotomy a normal biliary tree was found, and surgical liver biopsy disclosed severe tissue cholestasis and a granulomatous portal reaction constituted by white blood cells, eosinophiles and histiocytes, most of them atypical and some showing features of Reed-Sternberg cells. The second patient was a 21 year-old male with a febrile illness of four months duration who developed jaundice and progressive mental obtundation one week before admission. The biochemical studies demonstrated severe pancytopenia and signs of advanced liver failure. Percutaneous liver biopsy disclosed a normal hepatic architecture and the presence of numerous atypical histiocytes in the portal areas. Lymphography showed sizeable pelvic and paraaortic lymph nodes. Subsequent laparotomy for lymph node biopsy confirmed the diagnosis of Hodgkin's disease, nodular sclerosis type. The authors suggest that hepatic Hodgkin's disease must be considered in the differential diagnosis of any febrile illness with jaundice.