Hodgkin lymphoma presenting as generalized pruritus in an adolescent

Pruritus is a common manifestation of Hodgkin lymphoma (HL), and given its high frequency, inclusion of itching as a B symptom of HL has been proposed. We present a 16-year-old adolescent boy with treatment-refractory eczema of 2 years' duration. Physical examination revealed a thin adolescent...

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Bibliographic Details
Published inCutis (New York, N.Y.) Vol. 87; no. 4; p. 169
Main Authors Bartus, Cynthia L, Parker, Sareeta R S
Format Journal Article
LanguageEnglish
Published United States 01.04.2011
Subjects
Adolescent
Antineoplastic Agents - therapeutic use
Biopsy
Combined Modality Therapy
Diagnosis, Differential
Hodgkin Disease - diagnosis
Hodgkin Disease - therapy
Humans
Male
Physical Examination
Pruritus - diagnosis
Radiography, Thoracic
Stem Cell Transplantation
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Summary:Pruritus is a common manifestation of Hodgkin lymphoma (HL), and given its high frequency, inclusion of itching as a B symptom of HL has been proposed. We present a 16-year-old adolescent boy with treatment-refractory eczema of 2 years' duration. Physical examination revealed a thin adolescent boy with widespread excoriations, but no eczematous or primary cutaneous lesions were identifiable. Lymph node examination revealed palpably enlarged nodes in the cervical and supraclavicular regions. Laboratory studies revealed leukocytosis and an elevated lactate dehydrogenase level. Diffuse lymphadenopathy was detected on a chest radiograph, and excisional lymph node biopsy revealed HL (nodular sclerosing subtype). The patient was classified as HL stage IIIB (Ann Arbor staging classification) after further evaluation. Chemotherapy was initiated followed by radiation therapy. The patient's pruritus markedly improved within 2 cycles of chemotherapy; however, his HL relapsed and additional salvage combination chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant were required. This case underscores the need for a complete history as well as a careful skin and systemic evaluation in patients presenting with long-term pruritus, including children and adolescents.
ISSN:0011-4162