When itching signals more: A case of chronic pruritus leading to cancer diagnosis

Pruritus is a common complaint seen by emergency medicine physicians and carries a broad differential encompassing dermatologic, systemic, neurologic, and psychogenic etiologies. A 16-year-old girl presented to the emergency department with two months of pruritus and rash. Prior diagnoses for her symptoms included atopic dermatitis, medication-induced tactile hallucinations, and scabies. Physical examination in the emergency department was notable for a firm supraclavicular lymph node and laboratory studies were notable for systemic inflammation. Biopsy revealed a new diagnosis of classical Hodgkin lymphoma. Recognition of refractory chronic pruritus by frontline providers as a presenting symptom of Hodgkin lymphoma can prevent diagnostic delay.