Unilateral proptosis in an immunocompetent man as the initial clinical manifestation of systemic Hodgkin disease

OBJECTIVE: Orbital involvement in Hodgkin disease (HD) is rare. Previously reported cases of HD in patients without the acquired immunodeficiency syndrome have been diagnosed late in the course of established systemic disease. The authors describe an immunocompetent man with orbital infiltration as the initial manifestation of systemic HD. DESIGN: Case report. PARTICIPANTS: A 47-year-old man with acute progressive, painless proptosis of the left eye is described. INTERVENTION: A well-defined, homogeneous soft tissue mass of the superior left orbit was evident on computed tomography, and an incisional biopsy of the nontender mass was performed. RESULTS: The histopathologic findings were characteristic of HD. Systemic investigations showed clinical stage 3A HD. Ten months after completion of hybrid chemotherapy, the patient remained in complete remission from his HD. CONCLUSION: Hodgkin disease presenting initially in the orbit of a patient with the acquired immunodeficiency syndrome has been described previously. The patient presented in this report is the first case of HD in the recent English literature with the initial manifestation in the orbit of an otherwise immunocompetent patient.