Unilateral Ptosis in an Older Adult; a Rare Presentation of Primary Extranodal Hodgkin’s Lymphoma

Hodgkin lymphoma (HL) is a neoplasm arising from B cells characterized by the presence of Reed-Steenberg cells. Primary extranodal presentation is rare and accounts for less than 1% of all HL cases. In addition, the orbit is an uncommon site of extranodal HL, with only 9 cases reported in the literature. We present a case of an 84-year-old male who presented with right eye ptosis. He was diagnosed with stage IIE Orbital HL and treated with combined modalities of radiation and chemotherapy. He continues to be in complete remission after 1 year of therapy. Hodgkin’s disease has an excellent prognosis, and recent data show it is curable in at least 80% of the patients. Extranodal involvement represents systemic dissemination of Hodgkin’s disease in most cases and is usually considered an advanced-stage disease with a poor prognosis. In rare circumstances, extranodal involvement can be the primary manifestation. Unfortunately, there are only a few case reports and case series regarding this topic. We attempt to add another case to the literature emphasizing the prognosis and outcome of primary extranodal HL.