Inflammatory pseudotumor-like extranodal classic Hodgkin lymphoma manifesting as bowel perforation in acquired immunodeficiency syndrome patient with disseminated leishmaniasis: a case report and approach to differential diagnosis.

Abstract

Background: Classic Hodgkin lymphoma (CHL) is an extremely common non-acquired immunodeficiency syndrome (AIDS) defining malignancy and its incidence is rising. CHL is usually present in the lymph node and extranodal involvement is rare. Primary CHL of the gastrointestinal (GI) tract is exceedingly rare.

Case description: In this case, a patient with human immunodeficiency virus (HIV)/AIDS and disseminated leishmaniasis presented with a small bowel mass leading to bowel perforation. Histologically, the small bowel mass showed a transmural infiltrate of scattered large atypical multinucleated cells surrounded by histiocytes and T-cells. Initial differential diagnosis was wide due to the unusual presentation and cytologic atypia of the tumor cells. Identifying the Hodgkins Reed-Sternberg (HRS) cells with their unique immunophenotype was key for diagnosis.

Conclusions: It is critical to identify secondary CHL in HIV/AIDS patients especially in the presence of immunodeficiency and disseminated opportunistic infection. Extranodal primary GI tract CHL is exceedingly rare and thus awareness of this entity, which can mimic many other tumors, especially in immunocompromised individuals, is important. Special stains and cultures are helpful for the diagnosis, and antimicrobial therapy will induce successful clinical outcome. Overall, the unusual combination of acute clinical presentation, leishmaniasis, and HIV made the histological recognition of CHL crucial to avoid misdiagnosis and guide successful clinical management.