Chronic pruritus as the presenting symptom of Hodgkin lymphoma: A case report

A 25-year-old woman presented to the emergency department (ED) with acute chest tightness and dyspnea superimposed on a one-year history of diffuse, treatment-refractory pruritus that had been managed as eczema at two prior visits. She also reported night sweats and unintentional weight loss. Laboratory studies showed marked leukocytosis, transaminitis, critical hypokalemia and hypomagnesemia, and an elevated lactate dehydrogenase. No lymphadenopathy was palpable on examination. Chest radiography and computed tomography revealed a large, locally invasive right upper lobe mass with mediastinal, hilar, and cervical lymphadenopathy. The patient was transferred for tissue diagnosis, which confirmed nodular sclerosis classical Hodgkin lymphoma. Pruritus is a common ED complaint that typically reflects benign dermatologic disease; however, paraneoplastic pruritus can be the earliest sign of classical Hodgkin lymphoma and is frequently mistaken for eczema, potentially delaying diagnosis. Chronic, refractory pruritus accompanied by systemic symptoms or unexplained laboratory abnormalities warrants chest imaging, even without palpable lymphadenopathy, as it may represent an early, treatable presentation of Hodgkin lymphoma.