Difficulty of lifetime diagnosis of Hodgkin lymphoma: Case report

Hodgkin’s lymphoma (HL) is a rare B-cell lymphoid malignancy. Its clinical presentation is nonspecific and highly variable, which can complicate differential diagnosis. Differential diagnosis of HL includes infectious, autoimmune, and other malignant conditions. With timely treatment, mortality from this disease is extremely low. However, delays in therapy can lead to a worse prognosis and even death. The main symptom of HL is gradually developing asymmetric painless lymphadenopathy, which can remain asymptomatic for a long time. Ninety percent of young adults have lymph node involvement above the diaphragm, while only 10% have lymphoid organ involvement below the diaphragm. This clinical case of HL in a 48-year-old woman demonstrates the difficulties of antemortem diagnosis of this disease. The leading symptoms of the disease were fever and lymphadenopathy of the deep lymph nodes, which were determined by imaging studies. Overestimation of the results of imaging diagnostics, a low initial suspicion for malignancy, the absence of peripheral lymphadenopathy, and, consequently, difficulties in biopsy of the enlarged lymph nodes, along with the addition of coronavirus infection, prevented verification of the diagnosis during life and led to a fatal outcome. This article presents the stages of differential diagnosis and the impact of coronavirus infection on the course of the disease. This clinical case demonstrates the difficulties in interpreting the results of additional imaging diagnostics in HL and the lack of awareness among physicians of the clinical manifestations and diagnostic criteria of this disease.