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A Difficult Case of Hodgkin Lymphoma with Differential Diagnosis of Tuberculosis and Sarcoidosis.

Göknar N, Çakır E, Çakır FB, Kasapcopur O, Yegen G, Gedik AH, Oktem F - Hematol Rep (2015)

Bottom Line: The clinical symptoms and laboratory findings mimicking tuberculosis and sarcoidosis complicated the diagnostic process.He was diagnosed with Hodgkin's lymphoma after several X-rays, computed tomography, positron emission tomography-computed tomography, laboratory tests and three lymph node biopsy.Clinicians should be alerted on new lesions and symptoms in high risk patients and should repeat diagnostic tests and lymph node biopsies as indicated.

View Article: PubMed Central - PubMed

Affiliation: Bezmialem Vakif University , Istambul, Turkey.

ABSTRACT
We report here the case of a 14-year-old boy with history of fever, weight loss, and mediastinal lymphadenopathy. The clinical symptoms and laboratory findings mimicking tuberculosis and sarcoidosis complicated the diagnostic process. He was diagnosed with Hodgkin's lymphoma after several X-rays, computed tomography, positron emission tomography-computed tomography, laboratory tests and three lymph node biopsy. Clinicians should be alerted on new lesions and symptoms in high risk patients and should repeat diagnostic tests and lymph node biopsies as indicated.

No MeSH data available.


Related in: MedlinePlus

Microscopic examinations.
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fig003: Microscopic examinations.

Mentions: The next step was to investigate the patient for sarcoidosis. The angiotensin-converting enzyme (ACE) level was 91 U/L. He also had considerable hypercalciuria and a low parathormone level. Pulmonary function test was compatible with restrictive lung disease. The repeated thorax CT showed lymph node packs. Also seen were a round lesion of 47×37×30 mm in the right lung and bilateral parenchymal micronodular lesions. We diagnosed the patient as stage two juvenile sarcoidosis with constitutional symptoms, mediastinal lymphadenomegaly, nodular densities of the lungs, uveitis, arthritis, and hypercalciuria. The initial treatment was prednisone and methotrexate. After treatment his pains regressed, his sedimentation level decreased, and he gained weight. In the first week of the treatment myoclonic jerks occurred but electroencephalography, cranial magnetic resonance (MR) imaging, and MR angiography were normal. The etiology of myoclonus remained unclear. After two months of full-dose treatment with prednisone and methotrexate, we reduced the dosage of prednisone. His pains increased and he developed a new cervical lymph node. With suspicion of a new malignancy, we repeated the PET-CT. Cervical, supraclavicular, mediastinal, and right lung middle lobe hypermetabolic lymph nodes were detected. Standardized uptake values (SUV) increased considerably in comparison to the FDG screening which had been done four months before; SUV values ranged between 11.4 and 20.5 A cervical lymph node biopsy was done. Four months after the second biopsy, pathologic investigation revealed lymphocyte-rich classical Hodgkin lymphoma (Figure 3).


A Difficult Case of Hodgkin Lymphoma with Differential Diagnosis of Tuberculosis and Sarcoidosis.

Göknar N, Çakır E, Çakır FB, Kasapcopur O, Yegen G, Gedik AH, Oktem F - Hematol Rep (2015)

Microscopic examinations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508547&req=5

fig003: Microscopic examinations.
Mentions: The next step was to investigate the patient for sarcoidosis. The angiotensin-converting enzyme (ACE) level was 91 U/L. He also had considerable hypercalciuria and a low parathormone level. Pulmonary function test was compatible with restrictive lung disease. The repeated thorax CT showed lymph node packs. Also seen were a round lesion of 47×37×30 mm in the right lung and bilateral parenchymal micronodular lesions. We diagnosed the patient as stage two juvenile sarcoidosis with constitutional symptoms, mediastinal lymphadenomegaly, nodular densities of the lungs, uveitis, arthritis, and hypercalciuria. The initial treatment was prednisone and methotrexate. After treatment his pains regressed, his sedimentation level decreased, and he gained weight. In the first week of the treatment myoclonic jerks occurred but electroencephalography, cranial magnetic resonance (MR) imaging, and MR angiography were normal. The etiology of myoclonus remained unclear. After two months of full-dose treatment with prednisone and methotrexate, we reduced the dosage of prednisone. His pains increased and he developed a new cervical lymph node. With suspicion of a new malignancy, we repeated the PET-CT. Cervical, supraclavicular, mediastinal, and right lung middle lobe hypermetabolic lymph nodes were detected. Standardized uptake values (SUV) increased considerably in comparison to the FDG screening which had been done four months before; SUV values ranged between 11.4 and 20.5 A cervical lymph node biopsy was done. Four months after the second biopsy, pathologic investigation revealed lymphocyte-rich classical Hodgkin lymphoma (Figure 3).

Bottom Line: The clinical symptoms and laboratory findings mimicking tuberculosis and sarcoidosis complicated the diagnostic process.He was diagnosed with Hodgkin's lymphoma after several X-rays, computed tomography, positron emission tomography-computed tomography, laboratory tests and three lymph node biopsy.Clinicians should be alerted on new lesions and symptoms in high risk patients and should repeat diagnostic tests and lymph node biopsies as indicated.

View Article: PubMed Central - PubMed

Affiliation: Bezmialem Vakif University , Istambul, Turkey.

ABSTRACT
We report here the case of a 14-year-old boy with history of fever, weight loss, and mediastinal lymphadenopathy. The clinical symptoms and laboratory findings mimicking tuberculosis and sarcoidosis complicated the diagnostic process. He was diagnosed with Hodgkin's lymphoma after several X-rays, computed tomography, positron emission tomography-computed tomography, laboratory tests and three lymph node biopsy. Clinicians should be alerted on new lesions and symptoms in high risk patients and should repeat diagnostic tests and lymph node biopsies as indicated.

No MeSH data available.


Related in: MedlinePlus