Non-Hodgkin lymphoma masquerading as disseminated tuberculosis in the presence of constitutional symptoms, DRESS syndrome, and persistent generalized lymphadenopathy

Non-Hodgkin lymphoma masquerading as disseminated tuberculosis in the presence of constitutional symptoms, DRESS syndrome, and persistent generalized lymphadenopathy

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Persistent generalized lymphadenopathy (PGL) is the abnormal enlargement of more than two noncontiguous lymph node regions for more than 3 months.Tuberculosis, human immunodeficiency virus infection, and lymphoproliferative malignancies are predominant etiologies of PGL.Tuberculosis is the most common cause of PGL in India.

In here the present case report, a 41-year-old male presented with constitutional symptoms such as fever, anorexia, and weight loss with bilateral neck, axillary, and inguinal lymph node swellings for more than 3 months.She developed a skin rash and exfoliation after the initiation of empirical antituberculosis treatment (ATT) 3 weeks ago, with fine needle aspiration cytology (FNAC) lymph node cytology documenting reactive lymphadenitis.She was labeled as a case of disseminated tuberculosis due to the presence of PGL with hepatosplenomegaly, and empirical ATT was offered.

Her laboratory workup showed peripheral blood eosinophilia and abnormally raised liver function tests.These hematological abnormalities with the skin rash after initiation of ATT fulfilled the Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome criteria.A repeat cervical lymph node FNAC documented metastatic adenocarcinoma, with a negative workup for tuberculosis on cartridge-based nucleic acid amplification tests.

Excisional lymph node biopsy and histopathological examination confirmed non-Hodgkin lymphoma as the cause of PGL, and immunohistochemistry helped in the exact typing of Non-Hodgkins Lymphoma (NHL) as diffuse large B-cell lymphoma.We recommend a prompt evaluation of PGL cases with excisional lymph node samplings for infectious and malignant etiology workup rather than FNAC due to more reliable sample tissue for processing and lesser chance of fallacy.Additionally, biopsy techniques have a significant impact on final treatment argan oil pure purple outcomes in easily treatable infective pathologies versus dreadful malignant pathologies due to timely diagnosis.