Lymphoblastic Lymphoma Masquerading as Tuberculous Pleural Effusion
: Non-Hodgkin’s lymphoma (NHL) presenting as tuberculous pleural effusion is unusual. We present a case of NHL that was misdiagnosed as tuberculous pleural effusion and was managed with Anti-Tuberculosis Treatment (ATT) drugs. A 5-year-old female with a history of dry cough since more than a month, diagnosed as tuberculous pleural effusion and managed on ATT Category 1 drugs, was referred to us by a private independent clinic. Systemic examinations and result of investigations pointed towards the same diagnosis. Steroids were added to the regimen as multiple septa were observed on Ultra Sonography (USG), which helped us in improving the condition of the patient and once stable, she was discharged. Soon, after 7 days she presented with complains of dyspnea and examination and chest radiograph, revealed massive left sided pleural effusion. Thus, it led us to a conclusion that there was something other than tuberculosis, and hence Commuted Tomography Scan (CT scan) was advised that showed Lymphomatous involvement of supra-clavicularlymph nodes, excision biopsy was done and its histology and immunochemistry revealed T-cell lymphoblastic lymphoma a rare entity of NHL. A subsequent bone marrow biopsy showed invasion of bone marrow by atypical cells with high N:C ratio. Hence, ATT was stopped and is now managed with radiotherapy. Pleural effusion with Mantoux Test (MT) positive could be misleading as extra-pulmonary tuberculosis, especially for TB endemic setup, but a thorough investigation must be done prior to managing patients on ATT drugs. Further, due to increasing trends in incidence rates of NHL, we recommend a long term study to sort out a symptom cluster of NHL in developing setup.