A diagnostic surprise of Hodgkin’s Lymphoma in a 29-year-old long distance runner

Abstract

Painless lymphadenopathy enlarging over months is the most frequent presentation in Hodgkin’s lymphoma. Bony pain and lesions at presentation is usually not seen in Hodgkin lymphoma. However, in this case study, an uncommon presentation of classical Hodgkin’s Lymphoma, involving bone, in a 29-year-old long distance female runner was reported. Patient initially presented with bony pain without classic type B symptoms and lymphadenopathy. A final diagnosis of classical Hodgkin’s lymphoma stage IV was confirmed and PET scan evaluation was also done. Patient started on Escalated BEACOPP regimen and four cycles of chemotherapy were completed in 12 weeks and showed good response post treatment. Albeit, its rare, primary osseous Hodgkin’s Lymphoma should be considered in the diagnosis of bony pain. The absence of classic type B symptoms and any local lymphadenopathy in this case did make the diagnosis challenging. Keywords: Hodgkin’s lymphoma, bony pain, escalated BEACOP