Beyond The Basics: Unveiling Superior Vena Cava Compression in Hodgkin's Lymphoma

Abstract

Hodgkin's lymphoma (HL) is a malignancy of the lymphocytes in the lymph nodes and presents with non-specific systemic symptoms like fever, night sweats, and weight loss. While HL often involves the mediastinum, it rarely causes superior vena cava (SVC) syndrome, and eosinophilia is noted in approximately 15% of cases. Here, we report a unique presentation of HL in a 52-year-old male with a history of chronic pruritus, chronic kidney disease, and inactive hepatitis B. The patient presented with progressive cough and dyspnea over an eight-month period and developed right-sided ptosis, neck swelling, and engorged veins in the chest, suggesting Horner's syndrome and SVC syndrome. Imaging revealed an enlarged mediastinal mass and a pleural effusion, with subsequent biopsy confirming classical HL. Notably, the patient exhibited severe eosinophilia and a pruritic rash, which are uncommon features seen with HL. Following a multidisciplinary discussion, he was diagnosed with stage IV B x (bulky) HL and was started on a chemotherapy regimen with brentuximab vedotin plus AVD, which led to significant symptom resolution and reduction in tumor size. This case highlights the importance of considering HL in patients presenting with chronic pruritus, eosinophilia, and mediastinal masses. It emphasizes the need for comprehensive diagnostic evaluation in challenging cases and underscores the effectiveness of modern chemotherapy regimens in managing advanced stages of HL.

Keywords: abvd chemotherapy; anterior mediastinal mass; hematology-oncology; hodgkin’s lymphoma; hodgkin’s lymphoma presenting with eosinophilia; horner’s syndrome; right sided pleural effusion; superior vena cava (svc) syndrome; unique case.

Figure 1. Chest radiograph of the patient showing right-sided suprahilar mass-like lesion.

Figure 2. CT scan of the chest showing ‘soft tissue mass’ shown by the white arrows and the ‘pleural effusion’ noted by the blue arrows.

CT: computed tomography.

Figure 3. PET/CT showing a hypermetabolic mediastinal mass as indicated by the arrows.

PET/CT: positron emission tomography/computed tomography.

Figure 4. Chest radiograph showing worsening right-sided suprahilar parenchymal density/mass.

Figure 5. CT scan showing tumor compressing SVC causing compressive symptoms.

CT: computed tomography; SVC: superior vena cava.

Figure 6. CT scan of the chest, six months post-treatment, showing a reduction in the size of the lymphoma.

CT: computed tomography.