Hypercalcemia-Associated Hodgkin's Lymphoma Presenting as Normal Pressure Hydrocephalus: A Case Report

Hodgkin's lymphoma is a malignancy of the lymphatic system that can rarely present with advanced-stage features such as spinal cord involvement and hypercalcemia. We present the case of a 63-year-old Caucasian male with advanced Hodgkin's lymphoma, presenting with hypercalcemia and symptoms resembling normal pressure hydrocephalus. The patient exhibited gait impairment, altered mental status, and urinary incontinence, forming the classic triad seen in normal pressure hydrocephalus. Laboratory findings revealed leukocytosis, anemia, hypercalcemia, and acute kidney injury. Imaging showed extensive lymphadenopathy, a right adrenal mass, and bone marrow abnormalities suggestive of disseminated malignancy, leading to the decision not to biopsy the adrenal mass due to the strong suspicion of widespread metastatic disease. A biopsy of a mediastinal lymph node confirmed the diagnosis of Hodgkin's lymphoma, with hypercalcemia attributed to paraneoplastic syndrome. The patient's treatment included managing hypercalcemia and administering chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine. This case highlights the importance of considering Hodgkin's lymphoma in patients with atypical presentations and the need for comprehensive diagnostic evaluation, including imaging and laboratory tests. While hypercalcemia in Hodgkin's lymphoma is associated with a poor prognosis, newer therapies like brentuximab vedotin offer promising treatment options for frail patients.