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A 41-year-old man was admitted to the hospital because of fever of three weeks' duration.
Twenty-one years earlier, the patient had had Hodgkin's disease, with cervical, axillary, mediastinal, and perihilar lymphadenopathy. A staging laparotomy with splenectomy showed minimal splenic involvement and multiple negative retroperitoneal lymph nodes. Stage IIIB was assigned. He was treated with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone), which was ineffective and was replaced by ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine). Subsequently, he received mantle irradiation, followed by cycles of chemotherapy that included lomustine and vinblastine.
The patient was asymptomatic thereafter except for the development of hypothyroidism, which
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Dr. John G. Krikorian's Diagnosis
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