Concurrent Toxoplasmosis in a Patient with Hodgkin Lymphoma: A Case Report

A 14-year-old previously healthy boy was investigated for unilateral cervical lymphadenopathy. The biopsy of the posterior cervical lymph node was suggestive of toxoplasmosis. Polymerase chain reaction on blood for Toxoplasma gondii was also positive, however, his serology was negative for T. gondii-specific antibodies. A repeat cervical lymph node biopsy performed in a different hospital revealed classic Hodgkin lymphoma with co-existent toxoplasmosis thus the child was transferred to the National Cancer Institute, Sri Lanka for further management. He was started on anticancer chemotherapy as well as pyrimethamine-sulfadiazine and folinic acid for toxoplasmosis. As the child was intolerant to the pyrimethamine-sulfadiazine combination, he was started on co-trimoxazole and is on further follow-up. This case reiterates the importance of promptly ruling out sinister diagnoses such as malignancies when presenting with lymphadenopathy, and the need for concurrent management of co-existent, opportunistic infections that would impair the clinical outcome of the immunocompromised host.