A treatable cause of lymphocytic meningo-encephalitis.

Accepted 30 October 1996 A 59-year-old woman presented with anorexia, weight loss, lethargy, night sweats and lymphadenopathy. She was a lifelong teetotaller and was on no medication. Following biopsy of an inguinal node, a diagnosis of lymphocyte-depleted Hodgkin's lymphoma was established. Staging investigations showed pelvic and para-aortic node involvement (stage IIB). She went into remission following treatment with six courses ofABVD chemotherapy (adriamycin, bleomycin, vincristine, dexamethasone). During this period, she received 22 units of blood because of marked myelotoxicity. Three years later she had a left cervical nodal relapse that was treated with local radiotherapy. She was then noted to have increased skin pigmentation. A surveillance computed tomography (CT) scan revealed multiple 1-cm low density lesions in the liver (figure 1). The liver function tests were normal. As she declined a liver biopsy, she was treated with local radiotherapy on the assumption that she had metastatic liver disease. However, there was no change in the radiological appearance of these lesions following treatment. One year later, she developed a photosensitive rash and complained of recurrent painful blistering over the nose and back of hands. The liver profile was bilirubin 9 yumol/l (normal <17), aspartate transaminase 53 U/I (normal <40), y-glutamyl transferase 50 U/l (normal <35), alkaline phosphatase 182 U/l (normal 40-120). The serum ferritin was 1870 ug/1 (normal 12-400). The full blood count, urea and electrolytes, albumin and clotting screen were normal.