Refractory/Relapsed Classic Hodgkin Lymphoma Mimicking Disseminated Tuberculosis
<b>Background/Objectives:</b> Classic Hodgkin lymphoma (cHL) is a predominantly curable B-cell malignancy. However, primary refractory and relapsed (R/R) cHL remain therapeutic challenges, especially in regions with high tuberculosis (TB) prevalence, where clinical and radiologic feature...
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MDPI AG
2025-05-01
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| author | Mohamed Nazem Alibrahim Hussein Hammam Antonino Carbone Noor Alsaleh Annunziata Gloghini |
| author_facet | Mohamed Nazem Alibrahim Hussein Hammam Antonino Carbone Noor Alsaleh Annunziata Gloghini |
| author_sort | Mohamed Nazem Alibrahim |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> Classic Hodgkin lymphoma (cHL) is a predominantly curable B-cell malignancy. However, primary refractory and relapsed (R/R) cHL remain therapeutic challenges, especially in regions with high tuberculosis (TB) prevalence, where clinical and radiologic features overlap and can obscure the correct diagnosis. This article, presenting a case of R/R cHL mimicking disseminated TB, reviews the evolving paradigm in R/R cHL management. <b>Methods:</b> A 30-year-old Middle Eastern male with advanced nodular sclerosis cHL initially achieved a complete remission (CR) with escalated BEACOPP chemotherapy. Shortly afterward, he developed respiratory symptoms and diffuse miliary pulmonary nodules, highly suggestive of disseminated TB. Despite extensive negative TB workup, including QuantiFERON-TB Gold testing, sputum acid-fast bacilli (AFB) staining, and PCR, his imaging raised concern for recurrent cHL. Due to the small size and diffuse distribution of nodules, biopsy was unfeasible, prompting empiric salvage therapy with DEHAP-Carbo, brentuximab vedotin (BV), and nivolumab. <b>Results:</b> The rapid and robust metabolic response on PET/CT supported lymphoma relapse rather than TB. Following four cycles of this combined regimen, he proceeded to autologous stem cell transplantation and achieved a second CR. <b>Conclusions:</b> This case highlights the diagnostic difficulties in differentiating cHL relapse from TB in endemic regions, emphasizes the critical role of PET/CT in guiding therapy when histopathological confirmation is impractical, and illustrates the impact of novel immunotherapies in improving outcomes. By underscoring the importance of early diagnostic suspicion and multimodal assessment, this article also reviews the evolving paradigm in R/R cHL management, where personalized approaches and targeted agents increasingly complement or replace traditional chemotherapy regimens. |
| format | Article |
| id | doaj-art-c62191e2262f4d90aec70a835fc81d6d |
| institution | Kabale University |
| issn | 2673-6357 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Hemato |
| spelling | doaj-art-c62191e2262f4d90aec70a835fc81d6d2025-08-20T03:24:40ZengMDPI AGHemato2673-63572025-05-01621210.3390/hemato6020012Refractory/Relapsed Classic Hodgkin Lymphoma Mimicking Disseminated TuberculosisMohamed Nazem Alibrahim0Hussein Hammam1Antonino Carbone2Noor Alsaleh3Annunziata Gloghini4Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig 44511, EgyptEgyptian Military Medical Academy, Maadi, Cairo 11711, EgyptCentro di Riferimento Oncologico Aviano, IRCCS, 33081 Aviano, ItalyDepartment of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11555, EgyptDepartment of Advanced Diagnostics, Fondazione IRCCS, Istituto Tumori Milano, 20133 Milano, Italy<b>Background/Objectives:</b> Classic Hodgkin lymphoma (cHL) is a predominantly curable B-cell malignancy. However, primary refractory and relapsed (R/R) cHL remain therapeutic challenges, especially in regions with high tuberculosis (TB) prevalence, where clinical and radiologic features overlap and can obscure the correct diagnosis. This article, presenting a case of R/R cHL mimicking disseminated TB, reviews the evolving paradigm in R/R cHL management. <b>Methods:</b> A 30-year-old Middle Eastern male with advanced nodular sclerosis cHL initially achieved a complete remission (CR) with escalated BEACOPP chemotherapy. Shortly afterward, he developed respiratory symptoms and diffuse miliary pulmonary nodules, highly suggestive of disseminated TB. Despite extensive negative TB workup, including QuantiFERON-TB Gold testing, sputum acid-fast bacilli (AFB) staining, and PCR, his imaging raised concern for recurrent cHL. Due to the small size and diffuse distribution of nodules, biopsy was unfeasible, prompting empiric salvage therapy with DEHAP-Carbo, brentuximab vedotin (BV), and nivolumab. <b>Results:</b> The rapid and robust metabolic response on PET/CT supported lymphoma relapse rather than TB. Following four cycles of this combined regimen, he proceeded to autologous stem cell transplantation and achieved a second CR. <b>Conclusions:</b> This case highlights the diagnostic difficulties in differentiating cHL relapse from TB in endemic regions, emphasizes the critical role of PET/CT in guiding therapy when histopathological confirmation is impractical, and illustrates the impact of novel immunotherapies in improving outcomes. By underscoring the importance of early diagnostic suspicion and multimodal assessment, this article also reviews the evolving paradigm in R/R cHL management, where personalized approaches and targeted agents increasingly complement or replace traditional chemotherapy regimens.https://www.mdpi.com/2673-6357/6/2/12relapsed/refractory cHLHodgkin diseasetuberculosisimmunotherapystem cell transplantation |
| spellingShingle | Mohamed Nazem Alibrahim Hussein Hammam Antonino Carbone Noor Alsaleh Annunziata Gloghini Refractory/Relapsed Classic Hodgkin Lymphoma Mimicking Disseminated Tuberculosis Hemato relapsed/refractory cHL Hodgkin disease tuberculosis immunotherapy stem cell transplantation |
| title | Refractory/Relapsed Classic Hodgkin Lymphoma Mimicking Disseminated Tuberculosis |
| title_full | Refractory/Relapsed Classic Hodgkin Lymphoma Mimicking Disseminated Tuberculosis |
| title_fullStr | Refractory/Relapsed Classic Hodgkin Lymphoma Mimicking Disseminated Tuberculosis |
| title_full_unstemmed | Refractory/Relapsed Classic Hodgkin Lymphoma Mimicking Disseminated Tuberculosis |
| title_short | Refractory/Relapsed Classic Hodgkin Lymphoma Mimicking Disseminated Tuberculosis |
| title_sort | refractory relapsed classic hodgkin lymphoma mimicking disseminated tuberculosis |
| topic | relapsed/refractory cHL Hodgkin disease tuberculosis immunotherapy stem cell transplantation |
| url | https://www.mdpi.com/2673-6357/6/2/12 |
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