Hodkgin lymphoma concomitant of tuberculosis, a therapeutic challenge for multidisciplinary management

Hodgkin Lymphoma Mimicking Lumbar Spine Tuberculosis

Introduction. The clinical manifestations of Hodgkin lymphoma (HL) can closely mimic spine and lymph node tuberculosis (TB). Case Description. A 48-year-old man was initially treated for retroperitoneal lymph nodes TB, and this diagnosis was made without bacteriological and histopathological confirmation. After four months of regular therapy for TB, he did not improve and was admitted to our department for lumbar spine pain. We first made diagnosis of tuberculous spondylodiscitis, and anti-TB treatment was strengthened. But, after three weeks of hospitalization, his condition worsened clinically with onset of swelling of the left supraclavicular lymph node. So, after surgical excision and anatomopathological examination of the lymph node, the diagnosis of nodular sclerosis classic Hodgkin lymphoma was made. He was treated by chemotherapy, and his condition improved significantly after the first 2 cycles of chemotherapy. Conclusion. Repeated investigations may be helpful in establishing a correct diagnosis and starting an effective treatment in this highly curable disease.

Association of multifocal Hodgkin's lymphoma and tuberculosis infection: A challenging entity

The association of Hodgkin's lymphoma and Tuberculosis is a rare entity, resulting in misdiagnose or delay in diagnosis of both diseases, since they share similar signs and symptoms, laboratory tests results and imaging procedures.

We report the case of a 63 years old man who consulted for a clinical presentation of pulmonary and cervico-thoracic lymph nodes tuberculosis confirmed at the histopathological examination. The evolution after 5 months of antituberculous treatment was marked by the increase in size of the cervical nodes with a papular skin rash, diffuse abdominal pain and more weight loss. The FDG-PET-scan showed multiple confluent hypermetabolic lymphadenopathies on the whole upper body with cervical skin extension, next to hypermetabolic splenomegaly and focal liver hypermetabolism; next to a bilateral pleural effusion. The histopathological examination of the cervical lymph node specimen concluded to a Hodgkin lymphoma classified as Ann Arbor stage III. The chemotherapy protocol was started, while completing his antituberculous treatment. The patient passed away a few weeks later due to a septic shock.

We present this case to supplement the rare literature data concerning the association of Hodgkin's lymphoma and Tuberculosis, defining how they impact the prognosis of one another, in order to comfort the importance of tuberculosis screening in lymphoma patients, especially in endemic areas.

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The association of Hodgkin’s lymphoma and Tuberculosis is a rare entity.

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Diagnosis of tuberculosis concomitant with Hodgkin's lymphoma can be difficult resulting in misdiagnose or delay in diagnosis of both diseases.

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Histopathology and microbiological exams are crucial in distinction between TB and HL.

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Tuberculosis screening in lymphoma patients is essential, especially in endemic areas.