Primary Central Nervous System Hodgkin Lymphoma versus Lymphoproliferative Disorder in an Asymptomatic Immunocompromised Patient - A Case Report and Review of the Current Literature

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Primary central nervous system (CNS) Hodgkin’s lymphoma is extremely rare. An 82 year old female presented to the Emergency Department after she tripped and hit her head, resulting in a head laceration with no other apparent injuries. Head CT revealed a hyperdense area consistent with either a parieto-occipital hemorrhage or mass. She was transferred to a tertiary care institution, where head MRI revealed a parieto-occipital mass concerning for metastatic disease. No primary source or evidence of metastatic disease were found. The tumor was resected and identified to be a classical Hodgkin’s lymphoma, mixed cellularity type. The patient had no complications and was discharged home. Recommendations for patient’s future treatment included a PET scan and radiotherapy. After a consultation with a lymphoma expert at the NIH, the patient’s diagnosis was changed to an atypical lymphoproliferative disorder with Reed-Sternberg/Hodgkin like cells based on the patient’s history of rheumatoid arthritis treated with an immunosuppressant. A review of the literature revealed several primary CNS Hodgkin’s lymphoma cases that were extremely similar to the patient in this study. This case’s diagnosis as an atypical lymphoproliferative disorder casts doubt on if previously reported cases of CNS primary Hodgkin’s disease were misclassified as the pathological staining of this patient and the immunosuppressant history are extremely similar.