Simultaneous occurrence of Hodgkin disease and tuberculosis in children and adolescents.

Abstract

e20022 Background: The simultaneous co-existence (TB) and Hodgkin lymphoma (HL) is a rare entity is a rare entity. The similarities in signs and symptoms of both diseases: cough, fever, weight loss, night sweats, cervical or hiliar adenopathy can lead to delays in the diagnosis of either two entities. In addition, HL treatment with immunosupressors could lead to reactivation or worsening of TB imposing challenges on the initiation of HL treatment. Methods: Retrospective review of HL patients in Guatemala and Argentina from 2010 – 2019. Results: Ten patients with TB-HL were identified. Eight patients were from Guatemala and, 2 from Argentina. There were 4 females and 6 males. Age ranged from 4 – 17 years (mean 10.5 years, media 9 years). Eight patients were suspected to have TB by the referring physician and were found to have TB-HL upon histological and microbial testing of the same lymph node. Two patients were found to have TB-HL by tissue culture at the time of relapse. Initial systemic symptoms included fever (n = 7), weight loss (n = 5), and night sweats (n = 5). Two patients had no systemic symptoms but lymphadenopathy alone. Time for referral to oncology center ranged from 0.5 to 6 months. Histology consisted of nodular sclerosis (n = 5), mixed cellularity (n = 2), lymphocyte predominant (n = 1), lymphocyte depleted (n = 1), unknown (n = 1). Eight patients had advanced disease (stage IIB, IIIB and IVB) and, two stage IIA. HL treatment was given according to the institutional standards depending on stage and risk stratification with ABVD, OEPA/COPDac +/- Radiation therapy, and ICE for relapse. Five patients started anti TB treatment simultaneously with chemotherapy, and five others after completing 1 or 2 cycles of chemotherapy. TB treatment consisted of Isoniazid, Rifampin, Pyrazinamide +/- Ethambutol for 2 months followed by Isoniazid and rifampin for 30-52 weeks. Eight patients have been followed for 3 – 8 years and are alive without evidence of recurrence of TB or HL. One patient died during therapy, another died for causes not related to TB or HL having achieved remission for both. Conclusions: These small case series demonstrates that TB therapy can be given simultaneously with chemotherapy without risking worsening TB infection. Coexistence of TB and HL appears to correlate with advanced disease (higher stage and systemic symptoms) although it does not appear to affect outcomes. In areas were TB is endemic or the prevalence of TB is high, microbiology investigations of biopsy specimen should considered as part of the examination of tissue specimen that is considered to have HL.