Beyond The Basics: Unveiling Superior Vena Cava Compression in Hodgkin's Lymphoma

Hodgkin's lymphoma (HL) is a malignancy of the lymphocytes in the lymph nodes and presents with non-specific systemic symptoms like fever, night sweats, and weight loss. While HL often involves the mediastinum, it rarely causes superior vena cava (SVC) syndrome, and eosinophilia is noted in approximately 15% of cases. Here, we report a unique presentation of HL in a 52-year-old male with a history of chronic pruritus, chronic kidney disease, and inactive hepatitis B. The patient presented with progressive cough and dyspnea over an eight-month period and developed right-sided ptosis, neck swelling, and engorged veins in the chest, suggesting Horner's syndrome and SVC syndrome. Imaging revealed an enlarged mediastinal mass and a pleural effusion, with subsequent biopsy confirming classical HL. Notably, the patient exhibited severe eosinophilia and a pruritic rash, which are uncommon features seen with HL. Following a multidisciplinary discussion, he was diagnosed with stage IV B x (bulky) HL and was started on a chemotherapy regimen with brentuximab vedotin plus AVD, which led to significant symptom resolution and reduction in tumor size. This case highlights the importance of considering HL in patients presenting with chronic pruritus, eosinophilia, and mediastinal masses. It emphasizes the need for comprehensive diagnostic evaluation in challenging cases and underscores the effectiveness of modern chemotherapy regimens in managing advanced stages of HL.