Hemolytic anemia as an uncommon presentation of Hodgkin's lymphoma in a child

Haemolytic anaemia in childhood has an extensive differential diagnosis. We present a case of a twelve year old girl with haemolytic anaemia. A diagnosis of auto-immune haemolytic anaemia, probable Systemic Lupus Erythematosus was withheld. The girl was treated with immunosuppressive medication including prednisone and monoclonal anti-CD20 (Rituximab). After two years of follow-up a mediastinal mass was found and the diagnosis of Hodgkin’s lymphoma was confirmed. She was treated with chemotherapy and radiotherapy with good response. This case reminds us that Hodgkin’s lymphoma is not always an obvious diagnosis and that we should exclude this diagnosis in all patients with haemolytic anaemia or other auto-immune (like) manifestations