Panacea Journal of Medical Sciences

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Two are more dangerous than one-review of cases of coexisting tuberculosis and hodgkins lymphoma

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Case Series

Author Details : Kalpa Narayan Ghosh*, Girija Nair, Shahid Patel, Priya Deshpande, Nikhil Sarangdhar

Volume : 14, Issue : 2, Year : 2024

Article Page : 586-592

https://10.18231/j.pjms.2024.105

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Abstract

Background: The coexistence of tuberculosis (TB) and Hodgkin's lymphoma (HL) is a clinically challenging condition that poses considerable diagnostic and treatment challenges. TB is a contagious bacterial infection primarily affecting the lungs, while HL is cancer that originates in the bone marrow and lymphatics. Despite their subtle differences, the clinical and radiological manifestations of TB and HL overlap considerably, posing a diagnostic dilemma. While coexisting cases have been reported in literature, the myriad overlap between clinical manifestations and radiological findings of both diseases makes an accurate diagnosis difficult in such cases.
Case Report: A 23-year-old male from Badlapur, Maharashtra, India, presented with persistent cough, low-grade fever, breathlessness, chest pain, weight loss, and neck swelling for 3months. Imaging revealed cavitatory consolidation in the lungs and necrotic lymphadenopathy on HRCT findings. Bronchoscopic lavage confirmed Mycobacterium tuberculosis (TB) infection by CBNAAT. 4 months later he presented with bilateral chylothorax and large cervical lymphadenopathy, and further evaluation revealed coexisting Hodgkin's lymphoma on neck node tissue biopsy. PET-CT (Positron Emission Tomography and Computed Tomography)scan confirmed increased metabolic activity in lymph nodes and lungs.( increased metabolic activity in bilateral cervical, mediastinal, axillary, and cardiophrenic? lymph nodes. There was also increased metabolic activity in the soft tissue involving muscles of the left side of the neck and anterior mediastinum. Additionally, increased metabolic activity was noted in the regions of consolidation with surrounding nodules in both lungs, confirming the coexistence of TB and Hodgkin's lymphoma) Chemotherapy was commenced for Hodgkin's lymphoma ABVD Regimen(Adriamycin, Bleomycin, Vinblastine, Dacarbazine) and TB treatment with a 4-drug all-oral fixed-dose weight-adjusted regimen of HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol).The patient received a total of 8 cycles of chemotherapy and after 8 cycles of chemotherpy repeat PET CT revealed complete resolution of cervical lymphadenopathy and chylothorax.
 Conclusion: The coexistence of TB and Hodgkin's lymphoma is an uncommon but clinically challenging condition requiring a high index of suspicion index and prompt and thorough evaluation, so that timely treatment can be commenced to achieve absolute cure, in the coexistence of two conditions which are otherwise fatal. Diagnosis and management of such cases often requires a multidisciplinary approach, and timely initiation of appropriate treatment for both TB and Hodgkin's lymphoma is essential for optimal patient outcomes. Microbiology, biopsy and immunohistochemistry are crucial for accurate diagnosis.
 

Keywords: Tuberculosis, Hodgkin's lymphoma, coexisting tuberculosis and lymphoma

How to cite : Ghosh K N, Nair G, Patel S, Deshpande P, Sarangdhar N, Two are more dangerous than one-review of cases of coexisting tuberculosis and hodgkins lymphoma. Panacea J Med Sci 2024;14(2):586-592

Copyright © 2024 by author(s) and Panacea J Med Sci. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (creativecommons.org)