# A Rare Manifestation of a Rare Disease: Nodular Lymphocyte-Predominant Hodgkin Lymphoma Presenting As Paraneoplastic Aseptic Meningitis

## TL;DR

A rare case of a rare lymphoma presented as a meningitis-like condition, which improved after cancer treatment.

## Contribution

Reports a rare paraneoplastic manifestation of nodular lymphocyte-predominant Hodgkin lymphoma as aseptic meningitis.

## Key findings

- NLPHL can present with paraneoplastic aseptic meningitis without malignant cells in the CSF.
- Symptoms resolved following cancer treatment, supporting a paraneoplastic mechanism.
- Central nervous system involvement in NLPHL is uncommon and often atypical.

## Abstract

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is an uncommon form of Hodgkin lymphoma (HL). It commonly presents as chronic, asymptomatic, slow-growing peripheral lymphadenopathy. Central nervous system involvement in NLPHL is rare.

Here we report a case of a 28-year-old male patient who presented with a seven-week history of headache and neck pain. The evaluation revealed a diagnosis of subacute meningitis. He was newly diagnosed with NLPHL on lymph node biopsy. With this presentation of subacute aseptic meningitis with a negative workup for infectious, autoimmune etiology, and absence of malignant cells in the CSF, in the setting of newly diagnosed NLPHL, a diagnosis of paraneoplastic aseptic meningitis was made. The patient improved symptomatically with the treatment of his cancer.