Tormented by an "unrelenting" itch all over her body, a 41-year-old woman visited a series of doctors and specialists, only to repeatedly—and incorrectly—be diagnosed with eczema. But after more than a year of unsuccessful treatments, a new doctor took a different approach to find the real cause of her illness: Hodgkin lymphoma, Lisa Sanders writes for the New York Times.
A 'terrible itch'
On the day she helped her elderly father move, the patient—who'd been intermittently itchy for a few weeks—"suddenly developed a terrible itch…so deep inside her skin that she felt as if she couldn't scratch hard enough to really get to it," Sanders writes.
Thinking she might be having a reaction to "the dust and dirt" of the move, the patient went home, showered, moisturized, and went to bed, Sanders writes, but the itch returned later that evening. After two weeks of discomfort, the patient went to an urgent care clinic, where a doctor prescribed her a two-week course of prednisone to calm her itch. But although she took it "faithfully," it "didn't help," Sanders writes.
To ease the unrelenting itch, the woman then "cleaned every inch of her house," "hired an exterminator to search for bedbugs," had her pets treated for fleas, and "bought new mattresses"—but "[n]one of it helped." She also saw a dermatologist, who said it was eczema and suggested a moisturizer that was "useless." A visit with her internist was similarly unsuccessful. After running a few blood tests, he diagnosed her with mild anemia, which can cause pruritus, and prescribed an iron supplement that failed to provide her any relief.
After an allergist "found a reaction to dust mites and a chemical preservative used in some cosmetics and cleaning products called methylisothiazolinone (MIT)," the patient "bought an air purifier, put allergy covers on her (new) mattresses," cleaned out any products that had MIT, and started taking antihistamines, Sanders writes—but still, the itch continued. And when visits to two more dermatologists resulted in tentative diagnoses of eczema, "the patient burst into tears," worried she would "feel like this for the rest of her life."
Doctor examines the 'less likely causes'
More than a year after the itch had started, the woman visited Melissa Iammatteo, a specialist in allergy and immunology. During the first visit, the patient presented the "blotches of inflamed red skin" and "repeated the story she'd already told a half dozen times: she felt fine except for this terrible itch that drove her nuts."
But Iammatteo, "worried about problems that went beyond the skin." She pushed back on the patient's self-evaluation, asking if "she really [felt] fine." And when asked to consider her health critically, the woman admitted that she was tired, had recently lost some weight, and occasionally felt feverish.
Since the patient had already "had an extensive workup and seen many providers," Iammatteo forced herself to consider the "less likely causes" of the patient's pruritus. Accordingly, she ordered several tests for common "parasites or viruses" that can cause itching, HIV, and a chest X-ray for enlarged lymph nodes, since, Sanders writes, "[n]early 10% of patients with persistent unexplained pruritus are found to have cancer."
Finally, a diagnosis
Shortly after the visit, Iammatteo called the patient with news: The X-ray had found "a mass the size of a softball in her chest."
After meeting with a cancer specialist and undergoing a "flurry of blood tests, scans, and biopsies," the patient was diagnosed with "Hodgkin lymphoma, an unusual cancer of a type of white blood cell known as lymphocytes."
According to Sanders, patients are typically diagnosed with this cancer—which "usually starts in the chest or neck and spreads through the lymph nodes"—when they "develop enlarged lymph nodes in the neck or under the arms." And while the patient never had that symptom, she did have pruritus, Sanders writes, a less well understood symptom that up to 30% of Hodgkin lymphoma patients report having for "months or occasionally years before a diagnosis is made."
Overall, the news was positive, Sanders writes. While the treatment for this cancer is difficult—the patient had to undergo months of chemotherapy—her prognosis is good. Moreover, according to the patient, the unrelenting inch faded "significantly after the first round of chemo" and vanished entirely within six weeks (Sanders, New York Times, 4/14).