Mohd Fariz AMRI, Allia Najmie Muhammad YUSUF, Mohamad Shahrunizam Awang SETIA, Valerie Scarlett SEIBING, Sen Lin LEE
Gulhane Medical Journal - 2026;68(3):217-223
Lennert lymphoma (LL), a rare lymphoepithelioid variant of peripheral T-cell lymphoma (PTCL), is characterized by an indolent clinical course compared to other PTCL subtypes. The coexistence of LL and pulmonary tuberculosis (TB), particularly smear-negative TB, is extremely rare and presents unique diagnostic and therapeutic challenges. We report a case of a 76-year-old man with underlying type 2 diabetes mellitus who presented with progressive left inguinal swelling, night sweats, weight loss, and loss of appetite over four months. Examination revealed multiple bilateral cervical and inguinal lymphadenopathy. Laboratory tests showed anaemia, leukocytosis, and raised inflammatory markers. Histopathological examination of the inguinal lymph node demonstrated total effacement of the lymphoid architecture by malignant lymphoid cells, admixed with epithelioid histiocytes and Reed-Sternberg-like cells. Immunohistochemistry confirmed LL with a CD3+/CD4+/CD8- immunophenotype. Initial staging computed tomography (CT) revealed multi-organ lymphadenopathy and tree-in-bud nodules in the right upper lobe, suggestive of pulmonary TB. Repeated sputum examinations for acid-fast bacilli were negative. The patient was empirically treated for presumptive smear-negative pulmonary TB and LL. He was treated with cyclophosphamide, epirubicin, vincristine, etoposide, and prednisone chemotherapy and HRZE anti-tuberculous therapy. Empirical anti-tuberculous therapy showed clinical response radiologically; however, despite initial clinical improvement, diagnostic complexities and treatment interactions between lymphoma and TB.
