Bone marrow failure as a result of marrow involvement has been considered the major cause of pancytopenia in patients with Hodgkin's disease. We describe here the case of a patient with lymphocyte-depletion Hodgkin's disease in which the destruction of blood elements by intramedullary macrophages resulted in severe, refractory pancytopenia.
A 62-year-old white man presented with a 2-month history of night sweats and weight loss. At physical examination he was icteric; his temperature was 38 °C, pulse 90/min, respiratory rate 16/min, and blood pressure 90/60 mm Hg. Liver span measured 13 to 14 cm; the spleen tip was palpable. Ascites and