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Ban, Kang, Baeg, Kim, Kim, Baek, Kim, Ko, Lee, Moon, and Min: Coexistence of Hodgkin's Lymphoma and Tuberculosis in the Same Axillary Lymph Nodes
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 70(4): 342-346.

Published online: 30 April 2011

DOI: https://doi.org/10.4046/trd.2011.70.4.342

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

Woo Ho Ban, M.D.1, Hyeon Hui Kang, M.D.1, Myong Ki Baeg, M.D.1, Jae Gyung Kim, M.D.1, Hyun Jin Kim, M.D.1, In Woon Baek, M.D.1, Eun Oh Kim, M.D.1, Sun Hye Ko, M.D.1, Sang Haak Lee, M.D.1, Hwa Sik Moon, M.D.1, Ki Ouk Min, M.D.2

1Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

2Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea.

Address for correspondence: Sang Haak Lee, M.D. Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, 620-56, Jeonnong 1-dong, Dongdaemun-gu, Seoul 130-709, Korea. Phone: 82-2-961-4500, Fax: 82-2-968-7250, mdlee@catholic.ac.kr

Received 14 October 2010       Accepted 23 January 2011

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

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.

Keywords: Tuberculosis, Hodgkin Disease, Lymphadenitis

Figures and Tables

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).
trd-70-342-g004

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