Unexplained Hypotension in Hodgkin’s Disease

Abstract

A 51 -year-old black male with progressive polymyositis presented to our hospital with respiratory failure. Hemodynamic monitoring revealed tachycardia, arterial hypotension, a high cardiac index, and low systemic vascular resistance. Evaluation for common etiologies of this hemodynamic pattern was unrewarding. He was found to have Hodgkin’s disease of the bone marrow. Aggressive combination chemotherapy led to normalization of heart rate and arterial pressure. It is postulated that Hodgkin’s disease through some undetermined mechanism can cause a hyperdynamic circulatory pattern. This hemodynamic state reversed with suppression of the tumor

High cardiac output as a paraneoplastic syndrome

“…In these cases, vasoactive substances secreted by the tumour are believed to cause vasodilation and hypotension. No vasoactive mediator could be found in a recently described case report of Hodgkin's disease in a male subject with progressive polymyositis and high cardiac output [7]. In the present case we also suspected that soluble factors produced by lymphoma cells were possible mediators of the patient's haemodynamic profile with low peripheral resistance, and performed three sessions of plasma exchange which proved to be efficient in lowering monoclonal paraprotein, but not in improving the cardiac symptoms.…”