Hodgkin's Disease Exclusively With Bone Marrow Involvement

To the Editor.—  During the course of illness lymph node involvement may be detected in almost all patients with Hodgkin's disease.¹ Involvement of other organs such as spleen and liver is also common.² This report describes a patient who presented with pancytopenia. Reed-Sternberg cells were found in two bone marrow aspirations before starting chemotherapy and on bone marrow sections taken at autopsy. Neither clinical nor postmortem involvement of lymph nodes or other organs was detected.

Report of a Case.—  A 70-year-old man admitted to the hospital because of pancytopenia had noted only increasing fatigue and dyspnea on exertion during the previous five months. His medications included sulfinpyrazone (Anturane) and diazepam (Valium). Abnormal physical findings included pallor, petechiae over both lower extremities, and flame-shaped hemorrhages in the left fundus. There was no sternal tenderness, hepatosplenomegaly, or lymphadenopathy.Hemoglobin level was 9.8 gm/100 ml, reticulocyte count was 0.9%, mean corpuscular