Hodgkin Lymphoma Masquerading as Tuberculosis in a Young Chronic Smoker

Abstract

Hodgkin lymphomas are malignant hemato-lymphoid neoplasms involving lymph nodes and extra-nodal sites. Bone marrow infiltration at diagnosis is uncommon, occurring in approximately 10 % cases. Such infiltration, when present, is usually focal and often associated with extensive disease, systemic symptoms, cytopenias and unfavorable histology. In the unusual event of the absence of significant peripheral lymphadenopathy, these lymphoma-related B-symptoms may easily masquerade as an infectious illness. A 30-year-old male was initially administered inappropriate anti-tubercular chemotherapy in a primary care setting for a presumptive impression of pulmonary tuberculosis. On re-evaluation due to unresponsiveness to the drugs, bulky mediastinal lymphadenopathy was detected. However, his axillary lymph node aspirate revealed epithelioid cell granulomas further confounding the picture. The correct diagnosis of Hodgkin lymphoma was finally established when a bone marrow biopsy (for fever and pancytopenia) revealed the typical neoplastic Reed Sternberg cells that were confirmed immunohistochemically. The case highlights the necessity of an early bone marrow examination in patients with unexplained fever and peripheral blood cytopenias. Physicians in tropical third-world countries with resource constraints and high disease burdens need to strike a fine balance between maintaining a high index of suspicion for tuberculosis yet being wary of the risk of missing lymphoma in such patients.

Hodgkin Lymphoma Mimicking Lumbar Spine Tuberculosis

“…In front of lymph node or vertebral involvement suggestive of TB, when the anatomopathological examination shows only a granulomatous lesion without caseous necrosis and negative acid-fast staining, the clinician should evoke a diagnosis of lymphoma. A study reported the case of a 30year-old man, a chronic smoker who was initially treated for a presumptive impression of TB for 6 months without improvement [8]. At the initial diagnosis, there was hilar lymphadenopathy and a few very small (<0.5 cm) abdominal and axillary lymph nodes.…”

Two Cases of Synchronous Classic Hodgkin Lymphoma and Tuberculosis

“…As clinical presentation of lymphoma and tuberculosis are the same, definitive diagnosis is a challenging process (6). Immunohistochemical workup is required in most instances as the morphology may be altered by the ongoing other pathologies.…”

Lymph node tuberculosis mimicking malignancy on 18F-FDG PET/CT in two patients: A case report

“…Despite the reduction in the incidence of PTB worldwide, there has been no decrease in the frequency of LNTB. Lymphadenopathy, fever, weakness, night sweats, and weight loss are the most common clinical presentations of LNTB, causing a notable risk of confusing LNTB with lymphomas ( 12 , 13 ). Diagnostic imaging also presents challenges in the diagnosis of LNTB, as symptoms of LNTB may mimic those of other diseases such as neoplasms or sarcoidosis ( 6 ).…”