CRA54 DISSEMINATED TUBERCULOSIS MASQUERADING AS LYMPHOMA: A CASE REPORT

Vickneswaran Marathamuthu, Ummi Nadira Daut, Tasnim Abdul Aziz

Medical Department, Hospital Sultan Abdul Aziz Shah, University Putra Malaysia, Serdang, Malaysia

Introduction
Disseminated tuberculosis remains a diagnostic challenge, particularly in endemic regions, as its varied presentation can mimic malignancies like lymphoma. This report highlights a case where disseminated TB closely resembled lymphoma, emphasizing the need for vigilance in young adults presenting with lymphadenopathy and systemic symptoms.

Case Presentation
A 20-year-old female presented with painless cervical lymphadenopathy, intermittent fever, and unintentional weight loss. There was no prolonged cough or night sweats. Her father had previous history of multiple cancers and was diagnosed with pulmonary tuberculosis 7 years prior. Her CT imaging revealed extensive matted necrotic lymph nodes in cervical, mediastinal, and abdominal regions, along with bilateral pulmonary nodules, suggesting disseminated lymphoma. Biopsy revealed necrotizing granulomatous lymphadenitis without malignancy. Endoscopy and colonoscopy revealed granulomatous colitis via caecal tumour biopsy. TB-PCR on biopsy specimens confirmed Mycobacterium tuberculosis. The final diagnosis was disseminated TB involving lymph nodes, lungs, and the gastrointestinal tract. The patient was started on first-line anti-TB therapy and showed clinical improvement. Follow-up imaging is planned to assess subsequent response.

Discussion
This case highlights the diagnostic difficulty of disseminated TB, which can radiologically and clinically resemble lymphoma. Radiological features such as necrotic nodes and lung nodules, while suggestive of malignancy, are also common in TB. Tissue biopsy was crucial for accurate diagnosis. In TB-endemic areas, TB should be a key differential in young patients presenting with lymphadenopathy and systemic symptoms.

Conclusion
Disseminated TB can mimic lymphoma. Characteristic radiological findings may be misleading. Hence, histopathological confirmation is essential to differentiate TB from lymphoma or metastatic malignancy, enabling prompt anti-TB therapy and improved outcomes.