Coexistence of Hodgkin's Lymphoma and Tuberculosis in Two Young Adults: Diagnostic and Management Challenges

Tuberculosis (TB), primarily a pulmonary disease, can affect other organs and has been linked to an increased risk of Hodgkin's lymphoma (HL). Both conditions share similar clinical manifestations, including fever, night sweats, and weight loss, making diagnosis challenging. We report two cases of HL with a history of TB infection in childhood. The first case involved a 20-year-old female presenting with chronic cough, dyspnea, and weight loss. Imaging revealed an anterior mediastinal mass, and a biopsy confirmed classical HL. The patient received ABVD (doxorubicin, bleomycin, vincristine, and dacarbazine) chemotherapy followed by radiotherapy, leading to partial tumor regression. However, signs of TB reactivation emerged, prompting anti-TB treatment, which alleviated the symptoms. The second case involved an 18-year-old male with a persistent cervical mass initially misdiagnosed as TB lymphadenitis. Despite prolonged anti-TB therapy, the mass persisted and was later diagnosed as HL through immunohistochemistry. He underwent ABVD chemotherapy and radiotherapy, resulting in a favorable response. Together, TB and HL can coexist, complicating diagnosis and management. Clinicians should prioritize thorough diagnostic workups, including histopathology and immunohistochemistry, in patients with persistent lymphadenopathy or atypical TB presentations. Early differentiation between TB and HL is critical to ensure timely and appropriate treatment.