Exploring a possible shared pathophysiology in co-occurrence of multiple sclerosis and Hodgkin lymphoma: a case report and review of literature

INTRODUCTION Multiple sclerosis (MS) and Hodgkin lymphoma (HL) share common epidemiology, genetics and immunological factors. We report a case of a woman who presented with neurological deficits along with systemic symptoms fulfilling criteria for MS with synchronous HL. CASE PRESENTATION A 37-year-old woman presented with bilateral leg weakness, numbness and urinary retention which was preceded by three weeks of night sweats, 25-pound weight loss and anorexia. Neurological examination showed spastic paraparesis, sensory deficit and a left extensor plantar response. A magnetic resonance imaging (MRI) of brain showed multiple non-enhancing white-matter lesions, with patchy areas of peripheral gadolinium (Gd)-enhancement in the thoracic cord. Serology was positive for JC and EBV IgG antibodies. Body imaging revealed a mediastinal mass, and biopsy confirmed classical HL. The patient was given steroid infusions which resulted in mild improvements of leg weakness and numbness. She was started on doxorubicin, bleomycin, dacarbazine and vinblastine (ABVD) for HL. A Gd-enhanced MRI brain obtained after 4 cycles of ABVD showed resolution of enhancing lesions but new T2-FLAIR lesion consistent with active MS. Due to ongoing HL surveillance and concerns regarding immunosuppression, she was not started on disease-modifying therapy for MS. On her annual follow-up, she reported persistent fatigue, transient memory deficit and residual leg numbness. DISCUSSION The relationship between HL and MS has been explored in various studies, revealing an overlap in genetic susceptibility, shared biological pathways through lymphocyte-mediated immunity, JUN kinase activity, and tyrosine phosphorylation, and common environmental factors, such as the presence of EBV. Our patient presented with an atypical thoracic MRI finding of peripheral enhancement which led to further investigation and diagnosis of HL. The concurrent occurrence of MS and HL may point toward shared immune dysregulation. CONCLUSION We report a case of co-occurrence of MS with HL and note neurological stability after treatment with ABVD chemotherapy for HL. The shared genetics and immunological interplay may explain overlaps, but MS and HL still remain distinct pathologies.