A Rare Manifestation of Hodgkin’s Lymphoma- a Presentation as an Extensive Granulomatous Disease

The author reports a 24 years old female, presented with newly detected lump in her left breast, left upper limb edema and abdominal distension. She was diagnosed with TB lymphadenitis in view of caseating granuloma in FNAC which was performed in the initial hospital and was initiated on Anti tuberculosis treatment. After the intensive phase of Anti tuberculosis treatment, she developed drug induced hepatitis, hence ATT was stopped. In spite of adjusting dose modified ATT, her liver function deteriorated with worsening of clinical symptoms. Further evaluation showed extensive granulomatous lesions in the breast, multiple lymph nodes, liver and spleen. A new excision lymph node biopsy of lymph node revealed Nodular lymphocyte predominant Hodgkin’s lymphoma. Immunohistochemistry revealed positivity for CD20, PAX-5, OCT-2 and negative for CD3, CD15. Whole body PET CT showed multiple hypo dense nodules in liver and spleen, mediastinal and costal pleural deposits and soft tissue density nodules in left breast, left Latissimus dorsi, multiple skeletal sites suggestive metabolically active extra nodal lymphomatous deposits. She was treated with chemotherapy and she showed an excellent response.