Hodgkin lymphoma with hypereosinophilia in a pediatric patient: case report and review of the literature

Background: Hodgkin lymphoma (HL) comprises 6% of pediatric cancers, showing bimodal incidence in adolescence/young-adult and over 50 years. Characterized by Reed-Sternberg cells, HL is classified as classic/nodular lymphocytic predominant by WHO. Hypereosinophilia (>1,500/µL eosinophils) occurs in 15% of HL cases. Case report: A 17-year-old female presented with weight loss, night sweats, and malaise. Examination showed enlarged lymph nodes, splenomegaly, and palmoplantar erythema. Bloodwork revealed eosinophilia, hypoalbuminemia, and elevated lactate dehydrogenase levels. Bone marrow confirmed eosinophilic predominance. Lymph node biopsy diagnosed nodular sclerosis classical Hodgkin lymphoma (NS-cHL). PET-CT scan identified cervical, mediastinal, abdominal and spleen tumoral activity, classified as classical Hodgkin lymphoma or nodular lymphocyte-predominant Hodgkin lymphoma according to WHO criteria. OEPA/COPDAC treatment initiated, follow-up PET-CT showed incomplete metabolic response. She subsequently underwent radiotherapy, achieving complete metabolic response after treatment. Conclusion: This rare case illustrates profound hypereosinophilia concomitant with HL. Despite an extensive literature search, similar presentations are rarely reported in the literature. This case highlights an uncommon association between classical Hodgkin lymphoma and unusually high levels of hypereosinophilia, supported by the clinical course and the marked decline in eosinophil counts after lymphoma-directed therapy.