Hodgkin's lymphoma and tuberculosis coexistence in cervical lymph nodes

Abstract

We describe the case of a 47-year-old man admitted to the Department of Hematology because of fever, enlarged cervical and supraclavicular lymph nodes, hepatosplenomegaly and non-specific lung infiltrations. The histopathological examination of the cervical lymph node revealed Hodgkin's lymphoma (HL) NS type I. Clinical evaluation revealed stage IVB according to Ann Arbor classification and the presence of 5 unfavorable prognostic factors according to the International Prognostic Index. Despite BEACOPP chemotherapy (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), the enlarged lymph nodes, lung infiltrations and fever persisted. Microbiological and serological tests did not lead to the identification of any viral or bacterial pathogens. Bronchoscopy showed chronic inflammation and post-tuberculosis (TB) scars in bronchi without acid-fast bacilli in bronchoalveolar lavage (BAL) in culture and polymerase chain reaction (PCR) tests. However, the biopsy of the supraclavicular lymph node revealed multiple, caseating and necrotizing granulomatous lesions with scattered Reed-Sternberg (R-S) cells. The auramin staining presented acid-fast bacilli and allowed the diagnosis of productive and caseating TB coexisting with HL. The 4 tuberculostatics regimen and ABVD chemotherapy (adriamycin, bleomycin, vincristine, dacarbazine) resulted in a complete clinical response after 3 months of treatment. In conclusion, the association between HL and TB must be considered, especially in countries where the latter is endemic. The diagnosis may be difficult due to similarities in the clinical course, laboratory tests and imaging procedures.

A case of non-Hodgkin lymphoma coexisting with both hepatitis B and tuberculosis

“…[15] Non-Hodgkin lenfomalı hastaların büyük çoğunluğunda tedaviyle başarı sağlanmakla birlikte, tedavinin kısa ve uzun süreli toksik etkilerinin yakından takibi büyük önem taşımaktadır. [16,17] Özellikle kemoterapetiklere bağlı gelişebilen hepatotoksisite ve nefrotoksisite bu sorunların başında yer almaktadır. Bizim olgumuzda, karaciğe-re toksik olabilen kemoterapi ajanları kullanıldığı gibi eşzamanlı antitüberküloz antibiyotikler de kullanılmıştır.…”

Coexistent Nodal Diffuse Large B-Cell Lymphoma With Extrapulmonary Tuberculosis

“…[1][2][3]5,6 As the ongoing debate on which of the 2 entities is predisposing the other still continues, we report-to the best of our knowledgethe second case of DLBCL with coexistent tuberculosis involving cervical lymph node in the world and the first in India, in a patient with clinical presentation characteristic of tuberculosis.…”

“…The coexistent lymphoma reported in literature include 3 cases of Hodgkin's lymphoma, [1][2][3] one case each of low-grade non-Hodgkin's lymphoma (NHL) involving small bowel 4 and abdominal lymph node 5 and diffuse large B-cell lymphoma (DLBCL) involving cervical lymph node. 6 The various organs involved in coexistent lymphoma and extrapulmonary tuberculosis include bronchus, 7 small bowel, 4 …”

Lymphknotentuberkulose als Erstmanifestation eines Morbus Hodgkin

“…Die Erkrankung geht häufig mit unspezifischen Symptomen wie subfebrilen Temperaturen, Gewichtsverlust, Kopfschmerzen, Nachtschweiß oder Appetitlosigkeit einher, was die Abgrenzung gegenüber einer neoplastischen Grunderkrankung erschwert. In Assoziation mit Lymphomen finden sich zudem gehäuft extrapulmonale Manifestationen der Tbc in Organen, die auch eine Lymphominfiltration aufweisen können (Brust, Milz, Leber, Jejunum, Haut und LKs) [5,7,16,20,22,25,27], so dass der Gedanke an eine Tbc zunächst oft fern liegt.…”