Other / General Medicine
Hannah Levine, MD
Resident Physician
MedStar Georgetown University Hospital/National Rehabilitation Hospital
Washington, District of Columbia, United States
Elizabeth Raoof, MD
Resident Physician
MedStar Georgetown University Hospital/National Rehabilitation Hospital
Washington, District of Columbia, United States
Eric M. Wisotzky, MD
Chief Medical Officer
MedStar National Rehabilitation Hospital
Washington, District of Columbia, United States
Hannah Levine, MD
MedStar Georgetown University Hospital/National Rehabilitation Hospital
Wellington, Florida, United States
intercostobrachial neuralgia
A 54-year-old female with stage III nodular sclerosing Hodgkin’s lymphoma diagnosed after axillary dissection in July 2024 presented to clinic in May 2025. She received chemotherapy with brentuximab, adriamycin, bleomycin, vinblastine, and dacarbazine from July 2024 to January 2025. On initial presentation, she had chemotherapy-induced peripheral neuropathy in her distal extremities and hyperalgesia and tenderness to palpation along the left posteromedial upper arm and lateral chest wall. She had worsening pain with shoulder manipulation. This pain was consistent with intercostobrachial neuralgia. She had tried several neuropathic medications without improvement. She underwent intercostobrachial nerve block in June 2025 with immediate relief, later complicated by rebound pain secondary to cancer relapse.
Discussions:
The intercostobrachial nerve (ICBN) arises from the second intercostal nerve and the T2 nerve root. Intercostobrachial neuralgia commonly occurs in patients who have received axillary lymphadenectomy, affecting over 80% of patients. It presents as paresthesias to the posteromedial arm, axilla, and lateral chest wall, and largely affects breast cancer patients, though can present in anyone with axillary lymphadenectomy. Incidence in Hodgkin’s lymphoma patients, however, is rare, with no reported cases. This patient’s neuropathy was likely from intercostobrachial nerve injury related to her axillary lymphadenectomy. With lymphoma, peripheral neuralgias can occur from neurolymphomatosis, paraneoplastic neuropathy, and chest wall radiation. Treatment often involves oral and/or topical agents. Peripheral nerve block of the ICBN or serratus plane blocks at the second or third ribs can be considered.
Conclusions:
While intercostobrachial neuralgia is most associated with breast cancer, it can present in any patient with a history of axillary lymph node dissection or chest wall interventions. This case highlights the importance of keeping a broad differential for patients presenting with neuropathic pain, as we were able to address intercostobrachial neuralgia with a low-risk and targeted intervention, which allowed us to avoid increasing oral medications.
