In this report, we describe a case of classic Hodgkin lymphoma presenting with lytic bone lesions and pancytopenia, but with no significant lymphadenopathy or mediastinal mass. We report detailed clinical, radiologic, and pathologic findings. We discuss the scant medical literature of similar cases. We conclude that such cases often represent diagnostic challenges at the clinical and microscopic levels. We emphasize that awareness of this rare presentation of Hodgkin lymphoma is key to avoid diagnostic delay or interpretation pitfalls.