Alopecia Areata and Demyelination as Paraneoplastic Manifestation in Paediatric Hodgkin's Lymphoma

Abstract

Hodgkin's Lymphoma is one of the commonly encountered lymphomas in childhood. Most of the children present with lymphadenopathy. A rare subset of children do present with constellation of atypical symptoms as paraneoplastic syndromes. We hereby present an 11-year-old boy with classical Hodgkin's Lymphoma associated with Alopecia areata and demyelination as paraneoplastic manifestations. Both these paraneoplastic manifestations improved after initiating chemotherapy (ABVD regimen). A high index of suspicion for underlying malignancy would help clinicians in clinching an early diagnosis and would avert the associated complications.

Keywords: Alopecia areata; Hodgkin's lymphoma; Paraneoplastic syndrome; Pontine myelinolysis.

Figure 1

Contrast enhanced Computed Tomography (CECT) abdomen showing homogenously enhancing conglomerated mass forming lymph nodes in aortic and para-aortic region with encasement of abdominal aorta, IVC, and renal vessels extending from D11 to L4 vertebrae.

Figure 2

Biopsy of lymph node mass (Hematoxylin and eosin stain, magnification x 200) showing diffuse infiltration by mononuclear cells with large vesicular nuclei amnd occasional Reed Sternberg cells.

Figure 3

MRI brain, T2 Axial FLAIR showing trident shaped hyper-intensity in the central portion of pons.

Figure 4

MRI brain, Axial DWI showing trident shaped diffusion restriction in the central portion of pons corresponding with fig-3