Owattanapanich Weerapat, Phoompoung Pakpoom, Sukpanichnant Sanya
Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Case Rep. 2017 May 11;11(1):132. doi: 10.1186/s13256-017-1293-4.
Due to a similarity between the features of lymphoma and the features of tuberculosis, lymphoma may go unrecognized and undiagnosed in patients with tuberculosis.
A 33-year-old Thai man presented to our center with typical clinical manifestations of tuberculous lymphadenitis, with negative tests for both acid-fast bacilli and fungi, and negative polymerase chain reaction for Mycobacterial tuberculosis complex. The disease was not responding to anti-tuberculosis treatment and he developed both pericardial effusion and progressive lymphadenopathy. Large lymphoma cells were evident in the pericardial effusion, and a review of the previous lymph node biopsies confirmed the existence of ALK-positive anaplastic large cell lymphoma and tuberculous lymphadenitis. Moreover, when the tests were repeated, he was found to be positive for both acid-fast bacilli and Mycobacterial tuberculosis complex. The presence of typical morphology of tuberculous lymphadenitis and inattentional blindness may explain why the presence of large lymphoma cells was overlooked in one of the previous lymph node biopsies. Our patient developed severe pneumonia with profound septic shock due to carbapenem-resistant Enterobacteriaceae and died within days.
Given that tuberculosis and lymphoma can share common features, this case highlights the importance of thoroughly reviewing all foregoing relevant patient data (most notably pathology samples) in order to rule out the presence of lymphoma that may exist within the shadow of typical morphology of tuberculous lymphadenitis.
由于淋巴瘤的特征与结核病的特征存在相似性，淋巴瘤在结核病患者中可能未被识别和诊断。
一名33岁的泰国男子因结核性淋巴结炎的典型临床表现前来我院就诊，抗酸杆菌和真菌检测均为阴性，结核分枝杆菌复合群聚合酶链反应也为阴性。该疾病对抗结核治疗无反应，且出现了心包积液和进行性淋巴结病。心包积液中可见大量淋巴瘤细胞，回顾之前的淋巴结活检结果证实存在ALK阳性间变性大细胞淋巴瘤和结核性淋巴结炎。此外，再次检测时，发现他的抗酸杆菌和结核分枝杆菌复合群均呈阳性。结核性淋巴结炎的典型形态以及疏忽大意可能解释了为何在之前的一次淋巴结活检中忽略了大量淋巴瘤细胞的存在。我们的患者因耐碳青霉烯类肠杆菌科细菌感染发展为严重肺炎并伴有严重感染性休克，数天内死亡。
鉴于结核病和淋巴瘤可能有共同特征，该病例凸显了全面回顾所有先前相关患者数据（最显著的是病理样本）以排除可能存在于结核性淋巴结炎典型形态阴影下的淋巴瘤的重要性。
