Tuberculosis Mimicking Relapse of Hodgkin's Lymphoma in an Adolescent: A Diagnostic Pitfall in Tuberculosis-Endemic Regions

Hodgkin's lymphoma (HL) is a lymphoproliferative malignancy with high cure rates; however, the evaluation of suspected relapse remains a clinical challenge, particularly in tuberculosis-endemic regions, where infectious diseases may mimic neoplastic activity. We herein report the case of a 16-year-old male patient with a history of classic HL in complete remission who presented with a hypermetabolic pulmonary lesion associated with lymphadenopathy, initially suggestive of relapse. A histopathological analysis revealed caseous necrosis without evidence of malignancy, and tuberculosis was confirmed by polymerase chain reaction for Mycobacterium tuberculosis. The patient received standard antituberculosis therapy, achieving complete clinical resolution. He remains asymptomatic, without evidence of disease recurrence during the follow-up. The case herein reported highlights the diagnostic limitations of imaging studies and reinforces the importance of histopathological confirmation before initiating potentially-toxic therapies.