A rare case of Hodgkins lymphoma presenting with papulonecrotic tuberculid

Description

A 78-year-old man complained of pruritic skin lesions over the trunk and all limbs and occasional fever for 3 months. He had papulonodular skin lesions with erythematous base involving anterior as well as posterior aspects of the trunk and all limbs with predilection for extensor surface (figure 1). Mantoux test was negative. Skin biopsy showed features of papulonecrotic tuberculid (figure 2) with a negative Mycobacterium tuberculosis PCR and acid-fast bacilli stain. CT scan of the chest and abdomen showed multiple, enlarged mediastinal and retroperitoneal lymph nodes (largest 2.4 cm). Trucut biopsy and immunohistochemistry from retroperitoneal node revealed features of classical Hodgkin's lymphoma, nodular sclerosis variety with CD15 and CD30 positivity. In the absence of conclusive evidence of tuberculosis, he was treated with chemotherapy alone (oral prednisolone, etoposide, procarbazine and cyclophosphamide). Two months later, he is asymptomatic with partial resolution of skin lesions.

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