Hodgkin Lymphoma in a Female with Long-Standing Systemic Lupus Erythematosus

Abstract

Systemic lupus erythematosus (SLE) is associated with an increased risk of malignancies, particularly lymphomas. While non-Hodgkin lymphoma is more frequently reported, Hodgkin lymphoma (HL) represents a less common but clinically significant complication. We report a 48-year-old woman with an 18-year history of SLE who presented with pleuritic chest pain, dyspnea, fever, weight loss, and progressive lymphadenopathy. Imaging revealed left pleural effusion, splenomegaly, and widespread lymphadenopathy. Pleural biopsy was negative for malignancy. Excisional lymph node biopsy confirmed classical Hodgkin lymphoma, Ann Arbor stage III. The patient received BEACOPP followed by ABVD chemotherapy, achieving complete metabolic remission on PET-CT. Her treatment course was complicated by manageable neutropenia and mild anemia, which were addressed with supportive care. Close multidisciplinary monitoring by rheumatology and hematology ensured that her underlying SLE remained stable during chemotherapy. At follow-up, she reports good functional status and no recurrence of lymphoma symptoms. She remains in remission after 18 months of follow-up, with stable SLE on hydroxychloroquine and low-dose corticosteroids. This case highlights the critical importance of maintaining a high index of suspicion for malignancy in SLE patients who present with constitutional "B-symptoms" or rapidly progressive lymphadenopathy. It underscores the need for prompt investigation and tissue diagnosis to ensure appropriate oncological management in this high-risk population.