Evaluation of Lymphadenopathy in Urgent Care: A Case of Hodgkin Lymphoma.

Lymphadenopathy is a common presentation in urgent care and primary care settings and is most often due to benign or infectious causes. However, persistent or unexplained lymphadenopathy may represent an underlying malignancy, including Hodgkin lymphoma. We present the case of a 20-year-old female patient who presented to urgent care with a two-week history of cervical and axillary lymphadenopathy without B symptoms. Initial laboratory evaluation was notable for a positive mumps IgM, suggesting an infectious etiology. However, imaging revealed multistation cervical, axillary, and mediastinal lymphadenopathy concerning for a lymphoproliferative disorder. An initial core needle biopsy of an axillary lymph node was non-diagnostic; however, due to discordance between imaging and pathology findings, a repeat biopsy was performed, which confirmed classical Hodgkin lymphoma, nodular sclerosis subtype. The patient was subsequently referred for further oncologic evaluation and treatment. This case highlights the diagnostic challenges of evaluating lymphadenopathy when initial findings suggest an infectious process and emphasizes the importance of repeat biopsy when clinical suspicion for malignancy remains high.