Article
Classical Hodgkin lymphoma in a 10-year-old girl with systemic-onset juvenile idiopathic arthritis under IL-6 inhibition (Tocilizumab)
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Published: | September 1, 2015 |
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We report about a girl of Turkish origin with an already established diagnosis of congenital Myotonia Becker who was diagnosed with sJIA (Still´s disease) at the age of 10. Rapid improvement of rheumatic symptoms was achieved under IL-6 inhibition and steroids. However, after 11 months of treatment with Tocilizumab a supraclavicular swelling was observed, histologically corresponding to classical Hodgkin lymphoma.
Even though pathophysiology has not yet been fully elucidated, patients suffering from autoimmune diseases have an increased risk of cancer. Case reports show neoplasia under treatment with disease-modifying anti-rheumatic drugs (sDMARDs, especially TNFalpha inhibitors). However, a meta-analysis does not show an increased risk of development of cancer.
To our knowledge there is no published case of pediatric Hodgkin lymphoma under IL-6 inhibition. Development of solid tumors was reported but its incidence is not higher than in controls.
In our case, the period between initiation of IL-6 inhibition and diagnosis of Hodgkin’s lymphoma is rather short. Therefore it has to be considered that, when diagnosed with sJIA, the underlying condition might have been Hodgkin lymphoma already.
Furthermore we discuss the causal link between sJIA, Tocilizumab and development of Hodgkin’s lymphoma and want to raise awareness for the possible rare side-effects of a rather „new“ bDMARD.
The – possibly independent – occurrence of three rare conditions in one patient is also noteworthy.