Classical Hodgkin lymphoma masquerading as chronic recurrent multifocal osteomyelitis: a case report

Michael Pham, Steven Ressler, Allison Rosenthal, Katalin Kelemen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Hodgkin 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 presentation: A 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. Conclusions: This 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.

Original languageEnglish (US)
Article number45
JournalJournal of Medical Case Reports
Volume11
Issue number1
DOIs
StatePublished - Feb 18 2017

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Hodgkin Disease
Bone Marrow
Biopsy
Lymph Nodes
Musculoskeletal Pain
Dacarbazine
Vinblastine
Bleomycin
Hematologic Neoplasms
Diagnostic Errors
Non-Hodgkin's Lymphoma
Doxorubicin
Uncertainty
Needles
Lower Extremity
Anti-Inflammatory Agents
Therapeutics
Referral and Consultation
Drug Therapy
Chronic recurrent multifocal osteomyelitis

Keywords

  • Chronic recurrent multifocal osteomyelitis
  • Classical Hodgkin lymphoma
  • CRMO
  • Osseous lymphoma

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Classical Hodgkin lymphoma masquerading as chronic recurrent multifocal osteomyelitis : a case report. / Pham, Michael; Ressler, Steven; Rosenthal, Allison; Kelemen, Katalin.

In: Journal of Medical Case Reports, Vol. 11, No. 1, 45, 18.02.2017.

Research output: Contribution to journalArticle

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