Grand Rounds

Hodgkin’s Lymphoma with Tuberculosis

Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital and Incharge Pediatric HIV, TB and Liver Clinics, B J Wadia Hospital for Children, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056.

Clinical Problem :
A 12 years old boy presented with evening rise of fever for 4-5 months, bilateral otorrhoea for 1 month and loss of appetite. He was treated for cervical tuberculous lymphadenopathy 3 years ago and took antituberculous therapy {ATT} for 8 months. Ten months ago he had evening rise of temperature and cervical adenopathy. Fine needle aspiration was suggestive of tuberculosis {TB} with positive acid fast bacilli. He was started on ATT which he was taking till date. His HIV ELISA was negative. On examination, weight was 25.6 kg and height was 137 cm. He had matted cervical tender lymphadenopathy. A lymph node biopsy was done that showed complete loss of lymph node architecture and presence of Reed Steinberg cells suggestive of Hodgkin’s lymphoma.

Can TB and lymphoma co-exist_?

Discussion :
TB and lymphoma appear similar on clinical and radiological grounds and thus to differentiate between them is always a challenge. Several reports have reported coexistence of tuberculosis and non-Hodgkin lymphoma {NHL} in lymph nodes. {1-3} TB. It is postulated that immunosuppression that occurs during treatment for lymphoma can lead to TB. {4} Also in patients with TB, the risk of NHL is significantly increased. {5} Thus in a patient with tuberculous adenitis who is not responding to treatment, in addition to ruling out drug-resistant tuberculosis, one should also rule out lymphoma.

References :
  1. Sellar RS, Corbett EL, D'Sa S, Linch DC, Ardeshna KM. Treatment for lymph node tuberculosis. BMJ. 2010; 340:c63.
  2. Bellido MC, Martino R, Martínez C, Sureda A, Brunet S. Extrapulmonary tuberculosis and non-Hodgkin's lymphoma: coexistence in an abdominal lymph node. Haematologica. 1995; 80:482-3.
  3. Dres M, Demoule A, Schmidt M, Similowski T. Tuberculosis hiding a non-Hodgkin lymphoma "there may be more to this than meets the eye." Respir Med Case Rep. 2012;7:15-16.
  4. Kaplan MH, Armstrong D, Rosen P. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer. 1974;33:850–858.
  5. Askling J, Ekbom A. Risk of non-Hodgkin's lymphoma following tuberculosis. Br J Cancer. 2001;84:113–115.

Correct Answers :  yes 96%
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