Hodgkin lymphoma and tuberculosis coexistence in cerrical lymph nodes

Abstract

We describe a case of 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 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 (IPI). Despite of the BEACOPP chemotherapy the enlarged lymph nodes, lung infiltrations and fever persisted. Microbiological and serological tests did not lead to identification of any viral or bacterial pathogens. Bronchoscopy showed chronic inflammation and post tuberculosis (TB) scars in bronchi without acid-fast bacilli in bronchoalveolary lavage, culture and PCR tests, however the biopsy of 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 to diagnose productive and caseating TB coexisting with HL. The standard tuberculostatics regimen, administered simultanously with conventional and high-dose chemotherapy with peripheral blood stem cell support resulted in complete clinical response. In conclusion, the association between HL and TB must be considered, especially in the countries where the latter is endemic. The diagnosis may be difficult due to similarities in the clinical course, laboratory tests and imaging procedures.