Unusual presentation of Hodgkin disease-Painful hip

A 12-year-old girl presented with spontaneous onset of left hip pain. By plain radiographs and CT, she was found to have a femoral bone lytic lesion with peripheral sclerosis, adjacent to the physis of the left greater trochanter and no soft tissue mass. The differential diagnosis included osteomyelitis with abscess, eosinophilic granuloma, osteoid osteoma, osteoblastoma, or malignancy. Curettage of the lesion was pathologically characteristic of Hodgkin disease. A subsequent chest radiograph and CT unveiled an anterior mediastinal mass and multiple enlarged mediastinal lymph nodes. The patient is free of disease 7 years after receiving treatment with chemotherapy. Hodgkin disease should be considered in the differential diagnosis of symptomatic bone lesions. Prompt diagnosis will improve the management and effectiveness of therapy.