Tuberc Respir Dis.  2011 Apr;70(4):342-346.

Coexistence of Hodgkin's Lymphoma and Tuberculosis in the Same Axillary Lymph Nodes

• Ban WH
• Kang HH
• Baeg MK
• Kim JG
• Kim HJ
• Baek IW
• Kim EO
• Ko SH
• Lee SH
• Moon HS
• Min KO

Abstract

Herein we report the case of a 71-year-old woman who complained of fatigue and enlarged right axillary lymph nodes for 18 months. At her first visit, her chest X-ray showed diffuse nodular opacities in both lung fields. Initial excisional biopsy of the axillary lymph nodes showed granulomatous lesions and acid fast bacilli were seen on Ziehl-Neelsen staining. However, even after 15 months of anti-tuberculosis (TB) medication, her right axillary lymph nodes were enlarged. We re-performed an excisional biopsy of the nodes, which showed Hodgkin's lymphoma (HL). A retrograde review of the biopsy before anti-tuberculous medication, revealed HL coexisting with TB. HL and TB cause difficulties in differential diagnosis due to similarities in clinical course, imaging procedures and histopathological analysis of the involved tissue. Therefore, it is important to consider the possibility of concurrent HL and TB when patients who undergo treatment for TB or chemotherapy for lymphoma complain of persistent systemic symptoms or enlarged lymph nodes.

Keyword

Tuberculosis; Hodgkin Disease; Lymphadenitis

MeSH Terms

Aged
Biopsy
Diagnosis, Differential
Fatigue
Female
Hodgkin Disease
Humans
Lung
Lymph Nodes
Lymphadenitis
Lymphoma
Thorax
Tuberculosis

Figure

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  Figure 1 Initial chest X-ray (A) and computed tomography (B) shows multiple fine nodular opacities in both lung fields and multiple enlarged axillary lymph nodes (C, arrow).

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  Figure 2 The initial right axillary lymph node biopsy shows multiple granulomatous lesions with giant cell and diffused small lymphocytes (A, H&E stain, ×100). Acid fast bacilli (arrow) are seen on Ziehl-Neelsen stain (B, AFB stain, ×1,000).

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  Figure 3 Chest X-ray (A) and computed tomography (B) taken 15 months after anti-tuberculosis medication shows decreased infiltration in both lung fields, but axillary lymph nodes (arrow) are increased in number and size (C).

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  Figure 4 Biopsy taken after 15 months of antituberculosis medication shows multiple granulomatous lesions with diffused small lymphocytes and scattered macrophages (A, H&E stain, ×40), and mononuclear Reed-Stenberg cells (B, arrow, H&E stain, ×1,000).

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