Suspected malignant lymphoma presenting with widespread granulomatous lesions in bones and lymph nodes and responding...

A 61-year-old man presented with widespread granulomatous lesions of lymph nodes and bones, constitutional symptoms and various abnormal laboratory tests. An extensive investigation for the etiology including several biopsies, all showing granulomatous lesions, failed to reveal any specific underlying illness. A tentative diagnosis of sarcoidosis was made. However, corticosteroid therapy only temporarily improved the symptoms. Subsequently, standard chemotherapy for Hodgkin's disease induced complete clinical and biochemical remission. Rarely, the diagnosis of a lymphoma may be obscured by the presence of extensive granulomatous lesions. In these cases combination chemotherapy directed towards a malignant lymphoma may be justified in patients failing to respond to corticosteroid treatment.