![]() ![]() However, lymphomas can have a wide variety of presentations especially in early-stage disease, resulting in diagnostic delay. ![]() The typical presentation of lymphomas includes palpable lymph nodes (most commonly in the neck) and B symptoms that is fever, night sweats and unexpected weight loss > 10% over the last 6 months. ![]() ĭespite improved understanding of disease and advances in technology, lymphomas continue to present diagnostic challenges. HL is more common in children and young adults, with the nodular sclerosis subtype of classical HL predominating in this age group. It is characterised by the presence of Reed-Sternberg cells and accounts for approximately 15% of lymphomas (with 85% being non-Hodgkin). Hodgkin’s lymphoma (HL) is a rare B-cell lymphoma, accounting for 1% of all new tumour diagnoses worldwide. In smear-negative TB, lymphoma should be considered as a differential and definitive diagnostic tests such as molecular testing and histological examination of biopsies should be considered earlier in the diagnostic work-up to prevent diagnostic delay. Existing TB guidelines for smear-negative cases are not clear when to consider alternative diagnoses. Lymphoma is often misdiagnosed as TB, prolonging time to treatment and may adversely impact patient prognosis due to disease progression. Four months later, following clinical deterioration and further investigations, a mediastinal biopsy assisted in diagnosing Stage IV HL. An initial diagnosis of TB was made despite testing negative for acid-fast bacilli and anti-tubercular treatment was commenced. This was investigated with magnetic resonance imaging resulting in an incidental finding of mediastinal mass and pulmonary infiltrates. Case presentationĪ 23-year-old Asian female initially presented to rheumatology with over a one-year history of neuropathic pain, alongside abnormal white cell count and inflammatory markers. Written consent was obtained from the patient in compliance with ethical guidelines. We aim to highlight the diagnostic dilemma of TB versus lymphoma with an atypical presentation of HL and explored areas for further research and improvement with a non-systematic literature review using MEDLINE database and Google Scholar. Diagnosis of lymphomas can be difficult due to broad, non-specific presentations of disease, which can be similar to several other conditions ranging from infective, inflammatory or malignant causes, with one of the most common differentials being tuberculosis (TB). Hodgkin’s Lymphoma (HL) is a rare malignancy characterised histologically by the presence of Reed-Sternberg cells. ![]()
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