Possible misdiagnosis of HIV associated lymphoma as tuberculosis among patients attending Uganda Cancer Institute

Abstract

BackgroundEarly diagnosis of HIV associated lymphoma is challenging because the definitive diagnostic procedure of biopsy, requires skills and equipment that are not readily available. As a consequence, diagnosis may be delayed increasing the risk of mortality. We set out to determine the frequency and risk factors associated with the misdiagnosis of HIV associated lymphoma as tuberculosis (TB) among patients attending the Uganda Cancer Institute (UCI).MethodsA retrospective cohort study design was used among HIV patients with associated lymphoma patients attending the UCI, Kampala, Uganda between February and March 2015. Eligible patient charts were reviewed for information on TB treatment, socio-demographics, laboratory parameters (Hemoglobin, CD4cells count and lactate dehydrogenase) and clinical presentation using a semi structured data extraction form.ResultsA total of 183 charts were reviewed; 106/183 were males (57.9%), the median age was 35 (IQR, 28–45). Fifty six (30.6%) patients had a possible misdiagnosis as TB and their median time on TB treatment was 3.5 (1–5.3) months. In multivariate analysis the presence of chest pain had an odd ratio (OR) of 4.4 (95% CI 1.89–10.58, p < 0.001) and stage III and IV lymphoma disease had an OR of 3.22 (95% CI 1.08–9.63, p < 0.037) for possible misdiagnosis of lymphoma as TB.ConclusionA high proportion of patients with HIV associated lymphoma attending UCI are misdiagnosed and treated as TB. Chest pain and stage III and IV of lymphoma were associated with an increased risk of a possible misdiagnosis of lymphoma as TB.

High Cancer Burden Among Antiretroviral Therapy Users in Malawi: A Record Linkage Study of Observational Human Immunodeficiency Virus Cohorts and Cancer Registry Data

“…In addition, a single pathology center in Blantyre provided services to the entire country during the study period, and only approximately one-fifth of all cancer cases were thus pathologically confirmed. Lymphomas may be particularly susceptible to misdiagnosis, and studies from Uganda and Malawi have shown that lymphomas are commonly clinically misdiagnosed as tuberculosis [31,32]. Our study may also be subject to underreporting of cancer incidence during late patient follow-up.…”

Molecular Diagnostics for AIDS Lymphoma Diagnosis in South Africa and the Potential for Other Low- and Middle-Income Countries

“…Indeed, a retrospective review conducted in KwaZulu-Natal, South Africa, documented that 18 of 21 patients with lymphoma had been treated empirically for TB for a median of 5 months before the diagnosis of lymphoma was established and they were referred for lymphoma treatment. 18 In addition, a study from Uganda showed that 30.6% (56 of 183) of patients with HIV-associated lymphoma had received an average of 3.5 months of empiric TB treatment before the lymphoma diagnosis, 19 which suggests that this problem of possible delayed diagnoses is not isolated to South Africa.…”

Diagnosing lymphoma in the shadow of an epidemic: lessons learned from the diagnostic challenges posed by the dual tuberculosis and HIV epidemics

“…lymphadenopathy and B symptoms and similar investigation findings (cytopenias, granulomas on cytology, pleural effusions, hypodense splenic lesions, and tree-in-bud infiltrations on computerized chest tomography scan) [13]. Misdiagnosis of lymphoma as TB has been highlighted in several studies, showing that in TB endemic areas, up to 85% of patients with lymphoma may be initially misdiagnosed as TB [5,6].…”

“…Numerous barriers to diagnosis have been identified, including lack of symptom specificity, lack of a distinct referral pathway for lymphadenopathy, and difficulties in obtaining sufficient tissue for diagnosis, particularly as the fine needle aspirate (FNA) for cytology has a low diagnostic yield for lymphoma [4]. In TB endemic settings lymphoma diagnosis is further complicated by overlapping symptoms with extrapulmonary TB and lymphoma may frequently be misdiagnosed as TB [5,6].…”