Chronic Recurrent Multifocal Osteomyelitis-Like Paraneoplastic Syndrome as Initial Presentation of Nodular Sclerosis Classical Hodgkin Lymphoma.

Hodgkin lymphoma (HL) presenting with initial skeletal symptoms as a paraneoplastic phenomenon is extremely rare. Herein, we report the case of a 26-year-old man with nodular sclerosis classical HL (NSCHL) who presented with low back pain as the initial symptom. Imaging studies were unremarkable except for right S1-S2 sacral marrow edema on MRI, and multiple biopsies showed only inflammatory changes, resulting in a tentative diagnosis of chronic recurrent multifocal osteomyelitis. Later in the course of the disease, after performing routine series of MRIs, lymphadenopathy was finally detected. Core biopsies of the axillary and pelvic lymph nodes subsequently confirmed the diagnosis of HL. Complete resolution of bone lesions was observed following lymphoma treatment. This case highlights the diagnostic challenges of HL, particularly when it presents with rare skeletal paraneoplastic manifestations.