Title : Hodgkins lymphoma presenting as pneumonic consolidation
Abstract:
BACKGROUND: Hodgkins lymphoma is a group of cancers that arises from lymphatic system. Most common presentation is asymptomatic lymphnode enlargement typically in the neck. Pulmonary involvement is not uncommon . In this case report we describe a case of Pulmonary Hodgkin’s lymphoma presenting as pneumonic consolidation confrmed by histopathology.
CASE PRESENTATION: A 17 year old female presented with h/o breathlessness on exertion progressive in nature for past 2 years , persistent fever on and off for past 7 months, cough with expectoration for 7 months . Past H/O: CT CHEST: done 2 months back suggestive of consolidation bilateral upper lobes, right middle lobe, left lower lobe and mediastinal lymphadenopathy. Sputum AFB negative. Started on empirical Anti tubercular treatment based on radiological findings.
ASSESSMENT :
Fever profile: Malaria, Microfilaria, Leptospirosis, Dengue, Enteric Fever, Covid-19 – Negative.
Blood and urine culture: Negative
Bronchoscopy: Right middle lobe lumen narrowed. Bronchial wash cytology and biopsy: No malignant cells seen. Bronchial wash AFB, CBNAAT, bacterial and fungal cultures: Negative
Bone marrow aspiration: Erythroid predominance with megaloblastic changes.
Bone marrow Biopsy: Megaloblastic erythropoiesis.
Rheumatology: RF negative, ANA Hep 2 negative, ANA negative.
CT CHEST : No radiological resolution of consolidation
CT guided biopsy: HODGKINS LYMPHOMA
TREATMENT : Broad spectrum antibiotics initially
Hematologist opinion: Chemotherapy (ABVD regimen), Radiotherapy.
DISCUSSION: Hodgkins lymphoma usually presents as localized disease and spreads to contiguous lymphoid structures. Most common presentation is enlarged lymph nodes of neck, chest, axilla, abdomen or inguinal region.
CONCLUSION : Uniqueness of this case is its radiological presentation. Hodgkins lymphoma manifesting as consolidation makes it difficult to distinguish from concurrent infection. So possibility of lymphoma should be considered in non resolving consolidation with antibiotics and anti tubercular treatment .
Audience Takeaway:
- Should consider possibility of lymphoma in non resolving consolidation
- Persistent fever without cervical lymphadenopathy is yet another manifestation of lymphoma
- Image guided biopsy can be done in case of non resolving consolidation
- Persistence of symptoms and no radiological resolution even after antibiotics and anti tubercular therapy should raise suspicioin of malignancy
