YU.S. KITAEVA^1, 2, E.A. PRASKURNICHIY^3, 4, T.S. KONSTANTINOVA^1, 2, A.M.  OVIKOVA²

 ¹Sverdlovsk region Clinical Hospital No. 1, Yekaterinburg

²Urals State Medical University, Yekaterinburg

³Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow

⁴Russian Medical Academy of Continuous Professional Education, Moscow

 Contact details:

Kitaeva Y.S. — Assistant Lecturer of the Department of Propaedeutics of Internal Diseases

Address: 185 Volgogradskaya St., Yekaterinburg, Russian Federation, 620102, tel.: +7-922-115-83-64, e-mail: masa84@yandex.ru

 The problem of observation and treatment of patients with tuberculosis against the background of Hodgkin’s lymphoma is relevant today. Currently, few cases of managing patients with a combination of these diseases are presented in the Russian literature. A clinical case of observation and treatment of a patient with Hodgkin’s lymphoma and pulmonary tuberculosis is presented in the article. Due to the immunosuppression and myelotoxic neutropenia against the background of chemotherapy for Hodgkin’s lymphoma, the risk of infectious complications, including tuberculosis infection, increases. Diagnosis can be complicated by the atypical course of the infection, as well as the similarity of pathological processes.

The purpose was to analyze the features of the management of patients with Hodgkin’s lymphoma combined with pulmonary tuberculosis.

Material and methods. A retrospective analysis of the patient’s medical record was carried out, as well as her observation in a hematological hospital.

Results. In the primary diagnosis of Hodgkin’s lymphoma, the following methods were used: X-ray (CT, PET/CT), histological and immunohistochemical studies of the biopsy of the cervical lymph node, trepanobiopsy of the ilium, which allows to exclude the involvement of the bone marrow in the process. After 4 courses of PCT in the «escBEACOPP» mode, restaging was carried out. MSCT revealed an infiltrative lesion, which, unlike the tumor component, did not accumulate contrast. The patient was consulted by a phthisiatrician. The diagnosis of infiltrative tuberculosis was confirmed, and anti-tuberculosis therapy was prescribed. Subsequently, resection of S6 of the right lung was performed. When monitoring the response to the treatment, 6 months after the start of anti-tuberculosis treatment, CT revealed the progression of Hodgkin’s lymphoma. The council made a decision to continue PCT with a change in the scheme to «AVD + BV». After 6 courses of PCT, a complete metabolic response was noted.

Conclusion. In order to exclude errors in the differential diagnosis of Hodgkin’s lymphoma and tuberculosis lesions, histological confirmation and control using radiological methods are required. It should be noted that it is very important to treat both diseases simultaneously. If all conditions are met, it is possible to achieve control of the course and achieve positive results in the treatment of both diseases.

Key words: Hodgkin’s lymphoma, tuberculosis.

REFERENCES

1. Demina E.A. et al. Obshchie printsipy diagnostiki limfom: Rossiyskie klinicheskie rekomendatsii po diagnostike i lecheniyu zlokachestvennykh limfoproliferativnykh zabolevaniy [General principles for the diagnosis of lymphomas: Russian clinical guidelines for the diagnosis and treatment of malignant lymphoproliferative diseases], 2018. Pp. 9–27.
2. Zlokachestvennye novoobrazovaniya v Rossii v 2017 g. (zabolevaemost’ i smertnost’), pod red. A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoy [Malignant neoplasms in Russia in 2017 (morbidity and mortality). Ed. by A.D. Kaprin, V.V. Starinsky, G.V. Petrova]. Moscow: MNIOI im. P.A. Gertsena — filial FGBU «NMITs radiologii» Minzdrava Rossii, 2018.
3. Swerdlow S.H. et al. WHO classification of tumours of haematopoietic and lymphoid tissues. Revised 4th ed. Ed. Swerdlow S.H., Campo E., Harris N.L. et al. Lyon, France: International Agency for Research in Cancer (IARC), 2017.
4. Sharkunov N.N. Tuberkulez u bol’nykh limfoproliferativnymi zabolevaniyami, 2014 [Tuberculosis in patients with lymphoproliferative diseases, 2014], available at: http://www.hematology.ru/oncohematology/lymphomas/publication/012.pdf (accessed on: 31.10.2021).
5. Al’-Radi L.S., Moiseeva T.N., Chernova N.G., Sharkunov N.N., Margolin O.V., Shitareva I.V., Baryakh E.A., Klyasova G.A., Roshchina L.S., Kostina I.E., Kravchenko S.K., Pivnik A.V., Vorob’ev A.I. Tuberculosis in patients with lymphoproliferative diseases. Terapevticheskiy arkhiv, 2014, no. 11 (in Russ.), available at: https://cyberleninka.ru/article/n/tuberkulez-u-bolnyh-limfoproliferativnymi-zabolevaniyami (accessed on: 31.10.2021).