Extrapulmonary tuberculosis and non-Hodgkin's lymphoma: coexistence in an abdominal lymph node.

58-year-old woman with no significant medical history developed unexplained weight loss, anorexia, abdominal pain and distension. Physical examination revealed multiple masses in the abdomen, and radiographic studies showed multiple lymphadenopathies in all abdominal quadrants. A chest Xray was normal and she had no family or personal history of tuberculosis. Antibodies against the human immunodeficiency virus (HIV) were not found and lymphocyte subsets (CD4 and CD8) were normal. A diagnostic laparotomy was performed and several enlarged lymph nodes removed. Pathologic examination was consistent with a diagnosis of diffuse large cell (immunoblastic) B-cell lymphoma (Figure 1). Surprisingly, the same lymph nodes showed extensive areas of epithelioid giant-cell granulomas with central necrosis which were adjacent to the lymphomatous tissue (Figure 1). Acidfast bacilli were not observed with special stains, but a lymph node sample was sent for microbiologic study and grew abundant colonies of Mycobacterium tuberculosis. After complete staging, the patient was diagnosed as having isolated intra-abdominal lymph node tuberculosis coexistent with a stage IIB large cell lymphoma. She received six consecutive cycles of CHOP (cyclophosphamide, adriamycin, vincristine and prednisone) as well as antituberculous treatment with isoniazid + rifampicin (nine months) and pyrazinamide (three months). After finishing both treatments the patient was in complete lymphoma remission with no evidence of tuberculosis reactivation due to treatment-induced immunosuppression.