A 15-year-old female adolescent presented with progressive neck swelling of 1 year duration and received 6 months of antituberculosis therapy in a local hospital with no benefit. After excision biopsy, she came to our institution. Examination showed 3 fungating, ulcerating neck masses and a chest wall skin nodule. Pathology confirmed Hodgkin lymphoma, stage IV BXE. FDG PET/CT showed a large neck tumor, a satellite skin nodule with local skin infiltration of tumor. She received 6 cycles of ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy and radiation therapy 2100 cGy. After chemotherapy, FDG PET/CT was negative. She is 2 years disease free.