Emphasizing the Diagnostic and Management Challenge: Nodular Sclerosis Hodgkin Lymphoma with Pericardial Infiltration in an Adolescent Male - A Case Report

Hodgkin's lymphoma is a malignancy of lymphoid tissue with a generally favorable prognosis; however, symptomatic initial presentation with pericardial involvement is rare and presents significant diagnostic and therapeutic challenges. We report the case of a previously healthy 17-year-old male who presented with a four-month history of progressive cough and exertional dyspnea, along with a newly noticed right supraclavicular mass, without systemic B symptoms. Transthoracic echocardiography demonstrated a mild pericardial effusion, and subsequent PET-CT imaging revealed findings consistent with advanced disease. An excisional biopsy of the lymph node confirmed the diagnosis of nodular sclerosis classical Hodgkin lymphoma, and the patient was staged as Stage IV due to both pulmonary and pericardial involvement. Initial cytoreductive treatment with COP (Cyclophosphamide, Vincristine, Prednisone) was administered, followed by standard ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) chemotherapy. This case illustrates the importance of including lymphoproliferative disorders in the differential diagnosis of pericardial effusion. Furthermore, it emphasizes the importance of early imaging, histopathological confirmation, and a multidisciplinary approach in guiding appropriate treatment strategies. As this can help prevent severe complications and enhance the patient's prognosis.