A Rare Index Presentation of Hodgkin’s Lymphoma

Abstract

Hodgkin’s lymphoma almost invariably presents as generalised lymphadenopathy. Neurological involvement in Hodgkin’s is such a rare occurrence that not many case reports are available highlighting its importance. Also, cord compression more commonly occurs in non Hodgkin’s lymphoma rather than Hodgkin’s and is a manifestation of advanced disease. Refuting these common perceptions, the present case report discusses a 28-year-old male patient with complaints of low grade fever since three months followed by motor weakness of both lower limbs along with bladder involvement. Systemic examination revealed multiple lymph nodes in right cervical region along with features of extramedullary cord compression with spinal level at D4. Magnetic Resonance Imaging (MRI) revealed an epidural mass in the spinal canal extending from D2-D4, causing cord compression. Histological examination with immunohistochemical analysis of cervical lymph nodes demonstrated a mixed cellularity type Hodgkin’s lymphoma. With appropriate imaging and prompt pathology guided chemotherapeutic regimen, the neurological function were retsored without the need for any surgical intervention. Hence, it is important to also consider Hodgkin’s lymphoma in the setting of spinal cord compression along with other causes especially in Indian scenarios where tuberculosis is the closest differential bias encountered. Also, early diagnosis and evidence-based prompt treatment is crucial in preventing further neurological worsening and may curb the need for surgery.