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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize the signs and symptoms commonly associated with Hodgkin lymphoma (HL).

  • Discuss the pharmacotherapeutic treatment of choice and the alternatives available for treating HL.

  • Identify acute and chronic toxicities associated with the medications used to treat HL and the measures used to prevent, treat, and monitor these toxicities.

  • Determine monitoring parameters for response and toxicity in patients with HL.

  • Formulate appropriate educational information to provide to a patient receiving chemotherapy treatment for HL.

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PATIENT PRESENTATION

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Chief Complaint

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“I have been having night sweats, fever, and have been a lot more tired lately. I also have a growth on my chest that has gotten bigger over the past few weeks.”

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HPI

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Mike McCaffrey is a 27-year-old man who presents with a 1-month history of night sweats, fever, fatigue, and a 9-kg weight loss. He was previously working in finance but desired a career change and has been training for his interview and physical fitness test to join the local fire station. He served as a volunteer firefighter in college and missed that line of work. He denies any shortness of breath, and first attributed his fatigue to increased exercise. His wife also noticed a mass on his chest that has gotten progressively larger over the past 2 weeks. He initially associated the mass with an “elbow to the chest” he received during a recreation league basketball game. An ultrasound of the mediastinum showed a lymph node that measured approximately 11 cm. On physical exam, enlarged supraclavicular lymph nodes were noted on both the right and left. As a result, an excisional lymph node biopsy was performed that demonstrated classical HL, nodular sclerosing (NS) subtype.

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PMH

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None

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FH

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The patient’s parents and one sibling (brother, also a firefighter) are all in good health. Paternal grandfather died of colon cancer.

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SH

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Worked in finance, now training to join the local fire squadron. Drinks socially, about 2 beers per week. He has never smoked. He does not use illicit drugs. The patient is married and wishes to start a family.

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Meds

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Ibuprofen 400 mg PO Q 4–6 H PRN pain/fever

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All

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NKDA

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ROS

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  • (+) For fevers, night sweats, fatigue and weight loss of approximately 9 kg over the past month.

  • (–) For vision changes, headaches, shortness of breath, chest pain, nausea, vomiting, diarrhea, constipation, or urinary symptoms. Denies feeling depressed or having loss of pleasure with activities. His performance status is 1 on the ECOG scale.

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Physical Examination

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Gen
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The patient is ...

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