Marked eosinophilia proceeding diagnosis of Hodgkin lymphoma in the liver — a diagnostic dilemma

Eosinophilia may occur in various clinical conditions, including hematological malignancies such as Hodgkin lymphoma (HL), although it is usually diagnosed simultaneously with the disease. We report a case of a 72-year-old woman with persistent eosinophilia initially evaluated for hypereosinophilic syndrome. Despite extensive diagnostic workup, no cause of eosinophilia was identified. Six months later, imaging revealed multiple liver lesions, and liver biopsy confirmed classical HL, nodular sclerosis subtype. The patient’s condition rapidly deteriorated despite chemotherapy. This case highlights that persistent unexplained eosinophilia may precede HL diagnosis and requires continued clinical surveillance.