Successful Treatment for Isolated Bone Marrow Hodgkin Lymphoma in an Human Immunodeficiency Virus (HIV)-Negative Patient

Patient: Female, 36-year-old Final Diagnosis: Diffuse large B cell lymphoma Symptoms: Shortness of breath Medication:— Clinical Procedure: — Specialty: Hematology OBJECTIVE: Rare disease BACKGROUND: Hodgkin lymphoma is a type of lymphoid neoplasm characterized by the presence of Reed-Sternberg cells in histopathology. It presents with swollen lymph nodes, and in advanced cases, it can involve bone marrow. Isolated and primary involvement of Hodgkin lymphoma in bone marrow is a very rare presentation, especially in an HIV-negative patient, and has a high mortality rate, even with appropriate management. CASE REPORT: A 36-year-old male patient presented with a 6-month history of chills, night sweats, and generalized weakness. Laboratory investigations showed pancytopenia. A peripheral blood smear was unremarkable. A bone marrow biopsy revealed Reed-Sternberg cells, consistent with Hodgkin lymphoma. Further imaging did not show any lymphadenopathy, and the spleen was normal. Therefore, primary bone marrow Hodgkin lymphoma was diagnosed at stage IV, with an International Prognostic Score of 5 potential unfavorable factors. He was started on conventional chemotherapy for Hodgkin lymphoma and received the first cycle of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) during his hospitalization. Meanwhile, he had fever without focus, and was managed empirically by broad-spectrum antibiotic treatment (piperacillin-tazobactam). Hospitalization lasted for 2 weeks. He continued to receive other cycles as an outpatient, with good clinical response. The patient remained in complete remission after 2 years. CONCLUSIONS: Isolated Hodgkin lymphoma of bone marrow is a very rare scenario, especially in HIV-negative patients, with no established management for patients. Here, we report a patient successfully treated with a conventional chemotherapy protocol for Hodgkin lymphoma.