Abstract
BackgroundHodgkin lymphoma is a hematologic malignancy usually confined to lymphatic structures and commonly associated with constitutional symptoms. Bony involvement and musculoskeletal symptoms are uncommon and typically seen in advanced disease. In this case, we report an unusual presentation of classical Hodgkin lymphoma and highlight diagnostic challenges leading to the misdiagnosis and treatment as chronic recurrent multifocal osteomyelitis.Case presentationA 38-year-old white man presented with lower extremity musculoskeletal pain. Imaging studies revealed multifocal lytic and sclerotic osseous axial lesions. Multiple core needle bone marrow and excisional lymph node biopsies were non-diagnostic. Having met the criteria, a tentative diagnosis of chronic recurrent multifocal osteomyelitis was given. He was treated with non-steroidal anti-inflammatory medications with partial clinical response but had persistent symptoms. A second medical opinion was pursued. An open bone marrow biopsy was performed and yielded a diagnosis of classical Hodgkin lymphoma after 13 months of diagnostic uncertainty. A chemotherapy regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine was instituted with complete symptomatic and radiologic response.ConclusionsThis case illustrates diagnostic difficulties of a musculoskeletal presentation of Hodgkin lymphoma, challenges of non-diagnostic bone marrow and lymph node biopsies, and resultant diagnostic delays in delivering a potentially curative therapy. Had the additional open bone marrow biopsy not been performed, the diagnosis and treatment of Hodgkin lymphoma would have been missed.
Highlights
Hodgkin lymphoma is a hematologic malignancy usually confined to lymphatic structures and commonly associated with constitutional symptoms
Hodgkin lymphoma accounts for approximately 10% of all known lymphomas and has an annual incidence rate of approximately three cases per 100,000 people
Significant clinical and Discussion Here, we report a rare case of classical Hodgkin lymphoma mimicking a presentation of chronic recurrent multifocal osteomyelitis (CRMO)
Summary
The presenting complaint of musculoskeletal symptoms in our case affirms the heterogeneity of possible Hodgkin lymphoma presentations and enhances our appreciation for the diagnostic quandary this can entail. The misdiagnosis early in our patient’s clinical course highlights the pitfall of using a non-diagnostic bone marrow and lymph node biopsies to exclude Hodgkin lymphoma. Sacral pain as the initial symptom in primary Hodgkin’s lymphoma of bone. Ostrowski ML, et al Osseous Hodgkin disease. Hodgkin’s disease of the spine: Case report. Gebert C, et al Primary multifocal osseous Hodgkin disease: a case report and review of the literature. Griguolo G, et al A case of Hodgkin lymphoma in a patient with a history of bone pain and an initial diagnosis of chronic osteomyelitis.
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