Unveiling a diagnostic challenge: Rare pulmonary tuberculosis and subsequent pleural tuberculoma mimicking relapse of Hodgkin lymphoma

Pleural tuberculoma is a rare manifestation of tuberculosis (TB), particularly uncommon in individuals with an immunocompromised status. Its radiologic similarity to malignant disease often poses a diagnostic challenge. We report the case of a 31-year-old man with stage IV classical Hodgkin lymphoma, who was diagnosed with pulmonary TB through navigational bronchoscopic lavage. Despite remaining asymptomatic under ongoing anti-tubercular therapy, follow-up imaging revealed a newly developed pleural mass with intense fluorodeoxyglucose uptake on positron emission tomography and computed tomography, highly suspicious for lymphoma relapse. Diagnosis obtained via uniportal video-assisted thoracoscopic surgery confirmed the lesion to be a pleural tuberculoma. The anti-tubercular therapy led to progressive resolution of the lesions observed in follow-up imaging. This case underscores the importance of considering TB in the differential diagnosis of pleural masses in patients with immunocompromised status and highlights the critical role of histopathological confirmation to prevent misdiagnosis and inappropriate treatment escalation.