Prurigo nodularis is an uncommon pediatric cutaneous disorder that is associated with intense pruritus. We report a teenager with prurigo nodularis as the presenting sign of stage IIA Hodgkin's disease, primarily in the mediastinum. The pruritus and associated cutaneous lesions resolved with combination chemotherapy directed at the malignancy. In patients with prurigo nodularis and pruritus of unclear etiology, the possibility of underlying Hodgkin's disease must be considered.