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Classical Hodgkin lymphoma (cHL) outcomes in people living with HIV (PLWH) in South Africa are substantially worse than those in HIV-negative patients. Prior and current tuberculosis (TB) infection are common amongst PLWH and cHL in South Africa. We set out to evaluate the effect of active TB disease on presenting characteristics and outcomes in newly diagnosed cHL patients receiving care in Johannesburg, South Africa.

Background: There is a great geographic variation of extranodal natural killer (NK)/T-cell lymphoma, nasal type (NNKTL) prevalence, with a much higher prevalence in the Asian and South American populations. According to our knowledge and searches, only one other case report/study of NNKTL has been published in South Africa. Case presentation: We present a southern-African 31-year-old male residing in a township in the south of Johannesburg, South Africa. He presented with signs and symptoms similar to those of benign upper airway diseases. Further work-up of persisting signs and symptoms yielded a diagnosis of NNKTL. He was treated with the SMILE (steroids — dexamethasone, methotrexate, ifosfamide, L-asparaginase and etoposide) chemotherapy regimen, and sandwich radiotherapy was planned. He had a partial response to chemotherapy but unfortunately demised due to overwhelming sepsis prior to radiation therapy. Conclusion: Making a diagnosis of NNKTL in resource-limited settings is challenging as the diagnosis requires not only the demonstration of NK-cell markers but also to have a positive Epstein-Barr virus (EBV) in situ hybridization (EBER-ISH). Collaboration of smaller centres with larger and better equipped centres is required to diagnose and document NNKTL more accurately in the African setting.

Hepatosplenic T-cell lymphoma (HSTCL) is a rare type of Non-Hodgkin Lymphoma (NHL), grouped under the mature or peripheral T-cell lymphomas. It is characterised by extranodal infiltration and proliferation of malignant T-cells within the sinusoids of the liver, sinuses and red pulp of the spleen, and the bone marrow. The tumour cells express CD2 and CD3, but are CD4, CD5 and CD8 negative and express a clonally restricted gamma–delta (or less commonly alpha–beta) T-cell receptor. The disease has an aggressive clinical course associated with a poor prognosis. We highlight and report three patients from South Africa with HSTCL, all of whom had hepatosplenomegaly and cytopaenias, and despite being HIV seronegative and immunocompetent, had a poor outcome, with a mean survival of 7.5months in the two evaluable patients. This rare entity has not previously been reported from South Africa and as yet needs to be adequately characterised in a population where lymphoma is the most common haematological malignancy in adults, and where approximately two thirds of the adult lymphoma population are HIV seropositive.