An unusual presentation of endobronchial Hodgkin's lymphoma

Endobronchial involvement of Hodgkin's lymphoma is a rare presentation of the disease. However, it needs to be considered in patients presenting with non-resolving pneumonia in the setting of Hodgkin's disease. In such cases, clinicians need to ensure adequate and multiple biopsies as patients may have co-existent pulmonary infection and disease involvement. A 16 years old patient reported with a history of relapsed Hodgkin's disease, with bilateral pulmonary infiltrates, that failed to resolve after empiric antibiotic therapy. Positron Emission Tomography (PET) scan was performed demonstrating equivocal uptake in left upper lobe. Bronchoscopy revealed a necrotic endobronchial mass. Initial biopsy only revealed necrotic inflammatory debris, however, since the patient continued to lose weight, repeat biopsy was performed which demonstrated CD 30 positive Hodgkin's lymphoma cells.