Possible misdiagnosis of HIV associated lymphoma as tuberculosis among patients attending Uganda Cancer Institute

Paul Buyego,Stephen Walimbwa,Henry Ddungu,Rosalind Parkes-Ratanshi,Steven J Reynolds,Damalie Nalwanga,Lydia Nakiyingi

doi:10.1186/s12981-017-0139-x

Abstract

BackgroundEarly diagnosis of HIV associated lymphoma is challenging because the definitive diagnostic procedure of biopsy, requires skills and equipment that are not readily available. As a consequence, diagnosis may be delayed increasing the risk of mortality. We set out to determine the frequency and risk factors associated with the misdiagnosis of HIV associated lymphoma as tuberculosis (TB) among patients attending the Uganda Cancer Institute (UCI).MethodsA retrospective cohort study design was used among HIV patients with associated lymphoma patients attending the UCI, Kampala, Uganda between February and March 2015. Eligible patient charts were reviewed for information on TB treatment, socio-demographics, laboratory parameters (Hemoglobin, CD4cells count and lactate dehydrogenase) and clinical presentation using a semi structured data extraction form.ResultsA total of 183 charts were reviewed; 106/183 were males (57.9%), the median age was 35 (IQR, 28–45). Fifty six (30.6%) patients had a possible misdiagnosis as TB and their median time on TB treatment was 3.5 (1–5.3) months. In multivariate analysis the presence of chest pain had an odd ratio (OR) of 4.4 (95% CI 1.89–10.58, p < 0.001) and stage III and IV lymphoma disease had an OR of 3.22 (95% CI 1.08–9.63, p < 0.037) for possible misdiagnosis of lymphoma as TB.ConclusionA high proportion of patients with HIV associated lymphoma attending UCI are misdiagnosed and treated as TB. Chest pain and stage III and IV of lymphoma were associated with an increased risk of a possible misdiagnosis of lymphoma as TB.

Highlights

Diagnosis of HIV associated lymphoma is challenging because the definitive diagnostic procedure of biopsy, requires skills and equipment that are not readily available
HIV increases the risk of lymphoma, especially nonHodgkin’s lymphoma (NHL) [5] resulting in it being categorized as an AIDS defining illness [6]
We aimed to investigate the frequency and factors associated with lymphoma misdiagnosis as TB among a substantial population of HIV positive patients diagnosed with lymphoma attending the Uganda Cancer Institute, Mulago Hospital, Kampala

Summary

Introduction

Diagnosis of HIV associated lymphoma is challenging because the definitive diagnostic procedure of biopsy, requires skills and equipment that are not readily available. We set out to determine the frequency and risk factors associated with the misdiagno‐ sis of HIV associated lymphoma as tuberculosis (TB) among patients attending the Uganda Cancer Institute (UCI). 35 million people were living with HIV at the end of 2013 [1]. In 2013, an estimated 1.6 million Ugandans were living with HIV, and an estimated 63,000 people died of AIDS-related illnesses [3] including HIV related cancers. HIV increases the risk of lymphoma, especially nonHodgkin’s lymphoma (NHL) [5] resulting in it being categorized as an AIDS defining illness [6]. In Uganda the frequency of lymphomas NHL, the more frequent type has increased since the beginning of the HIV/ AIDS pandemic in the early 1980s [7]. The Kampala Cancer Registry reports the incidence of NHL in Kampala is increasing by 6.7%

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