Epitheloid granuloma of bone marrow- not always tuberculosis, think beyond what you see
DOI:
https://doi.org/10.18203/2349-3291.ijcp20212486Keywords:
Fever of unknown origin, Bone marrow biopsy, Epithelioid granuloma, Hodgkins lymphomaAbstract
Extra pulmonary tuberculosis has varied presentations and hence fever of unknown origin, with malaise, weight loss and cytopenias is generally attributed to tuberculosis in endemic regions. Tuberculosis being the most frequent cause of bone marrow granulomas, there is a risk of labelling granulomatous lesions as of infectious etiology when underlying etiology has an atypical presentation. Progressive painless lymphadenopathy, most commonly involving the cervical or supraclavicular area is the commonest presentation of Hodgkin’s lymphomas (HL) in 80%. Primary extra nodal presentation of HL is rare. We describe a case of an adolescent girl who presented with fever of unknown origin, weight loss, malaise, hematological derangements and bone marrow showing granuloma, all features pointing towards an infectious etiology, but later proven to be a case of HL.
References
Fried G, Ben AY, Haim N, Dale J, Stein M. Primary Hodgkin's disease of the bone. Med Pediatr Oncol. 1995;24(3):204-7.
Carroll DI, Kenna RW, Brunning RD. Bone marrow manifestations of Hodgkin's disease. Cancer. 1976;38(4):1717-28.
Avasthi R, Mohanty D, Chaudhary SC, Mishra K. Disseminated tuberculosis: interesting hematological observations. J Assoc Physicians India. 2010;58:243-4.
Singh KJ, Ahluwalia G, Sharma SK, Saxena R, Chaudhary VP, Anant M. Significance of haematological manifestations in patients with tuberculosis. J Assoc Physicians India. 2001;49: 790-4.
Munker R, Hasenclever D, Brosteanu O, Hiller E, Diehl V. Bone marrow involvement in Hodgkin's disease: an analysis of 135 consecutive cases. German Hodgkin's Lymphoma Study Group. J Clin Oncol. 1995;13(2):403-9.
Bhargava V, Farhi DC. Bone marrow granulomas: clinicopathologic findings in 72 cases and review of the literature. Hematol Pathol. 1988;2(1):43-50.
Koo SE, Park CJ. Granulomatous bone marrow involvement of Hodgkin lymphoma, nodular sclerosis type. Blood Res. 2017;52(2):82.
Daly PA, Briain DS, Robinson I, Guckian M, Prichard JS. Hodgkin's disease with a granulomatous pulmonary presentation mimicking sarcoidosis. Thorax. 1988;43(5):407-9.
Bhatia A, Kumar Y, Kathpalia A. Granulomatous inflammation in lymph nodes draining cancer: A coincidence or a significant association. Int J Med Medical Sci. 2009;1:6-13.
Sacks EL, Donaldson SS, Gordon J, Dorfman RF. Epithelioid granulomas associated with Hodgkin's disease: clinical correlations in 55 previously untreated patients. Cancer. 1978;41(2):562-7.