Shi Ying TAN, Pemasiri Upali TELİSİNGHE, Justin Fook Siong KEASBERRY

Painless cervical lymphadenopathy in an elderly patient – a rare case of Rosai-Dorfman disease and Hodgkin's lymphoma

Rosai-Dorfman disease (RDD) is a rare, benign disease with extensive lymphadenopathy. In this case, an 81-year-old gentleman with previous pulmonary tuberculosis presented painless cervical lymphadenopathy associated with generalized weakness, loss of appetite, and cough. The causes of cervical lymphadenopathy in the elderly are comprehensive; thorough history, examination, and appropriate investigations are vital in diagnosing diseases. A lymph node biopsy is recommended if blood investigations and imaging are inconclusive. He was later diagnosed with RDD associated with Hodgkin’s lymphoma, and dexamethasone treatment was initiated. Concomitant diagnoses are rare but should not be disregarded. This case report is a reminder that RDD remains a differential diagnosis of cervical lymphadenopathy. Regular monitoring is required as immune dysregulation from the treatment of RDD may exacerbate quiescently treated pulmonary tuberculosis.

Keywords:

lymphadenopathy, rosai-dorfman disease, histiocytosis,

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Rosai J, Dorfman RF. Sinus histiocytosis with massive lymphadenopathy: A pseudolymphomatous benign disorder. Analysis of 34 cases. Cancer. 1972 Nov;30(5):1174-88. doi: 10.1002/1097-0142(197211)30:5<1174::aid-cncr2820300507>3.0.co;2-s.
Evaluation of peripheral lymphadenopathy. Available at: https://www.uptodate.com/contents/evaluation-of-peripheral-lymphadenopathy-in-adults. Accessed 30 November 2021.
Kumar B, Karki S, Paudyal P. Diagnosis of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) by fine needle aspiration cytology. Diagn Cytopathol. 2008 Oct;36(10):691-5. doi: 10.1002/dc.20904.
Iqbal M, Subhan A, Aslam A. Frequency of tuberculosis in cervical lymphadenopathy. J Surg Park (International). 2010 Apr-Jun;15(2):107-9.
Sharma S, Bhardwaj S, Hans D. Rosai-Dorfman Disease. JK Science: Journal of Medical Education and Research. 2010 Oct-Dec; 12(4):194-6.
Edelman A, Patterson B, Donovan K, Malone J, Callen J. Rosai-Dorfman disease with a concurrent mantle cell lymphoma. JAAD Case Rep. 2018 Dec;5(1):40-3. doi: 10.1016/j.jdcr.2018.09.017.
Bruce-Brand C, Schneider JW, Schubert P. Rosai-Dorfman disease: An overview. J Clin Pathol. 2020 Nov;73(11):697-705. doi: 10.1136/jclinpath-2020-206733.
Reddy RC, Mathew M, Parameswaran A, Narasimhan R. A case of concomitant Hodgkin’s lymphoma with tuberculosis. Lung India. 2014 Jan;31(1):59-62. doi: 10.4103/0970-2113.125985.
Centkowski P, Sawczuk-Chabin J, Prochorec M, Warzocha K. Hodgkin’s lymphoma and tuberculosis coexistence in cervical lymph nodes. Leuk Lymphoma. 2005 Mar;46(3):471-5. doi: 10.1080/10428190400019891.
Hsiao CH, Tsai TF, Yang TH, Liu CM. Clinicopathologic characteristics of Rosai-Dorfman disease in a medical center in Northern Taiwan. J Formos Med Assoc. 2006 Sep;105(9):701-7. doi: 10.1016/S0929-6646(09)60197-2.
Zacharia B, Manicam K. Primary Rosai-Dorfman disease of the proximal radius masquerading as tuberculosis of elbow. Cureus. 2020 Apr;12(4):e7858. doi: 10.7759/cureus.7858.
Parkash O, Yousaf MS, Fareed G. Rosai-Dorfman’s disease, an uncommon cause of common clinical presentation. J Pak Med Assoc. 2019 Aug;69(8):1213-5.
Elo-Ilo J, Odinaka KK, Ukah C. Rosai-Dorfman disease in a 12-year-old Nigerian male. SAJCH. 2016 Dec;10(4):237-8. doi: 10.7196/sajch.2016.v10i4.1197.