Cardiac Involvement as First Manifestation of Peripheral T-Cell Not Otherwise Specified Lymphoma.

Abstract

Cardiac involvement as the first manifestation of peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) is extremely rare. We report on a 72-year-old man with hypertension, dyslipidaemia and prediabetes who presented with acute pleuropericarditis, pericardial effusion and conduction abnormalities. Despite initial treatment, his condition worsened. Imaging revealed pericardial/myocardial infiltration and a right atrial mass. Biopsy confirmed PTCL-NOS (CD3+, CD5+, CD7+, high Ki-67). Complications included ileus, pulmonary embolism and neutropaenia. CHOP failed; GemOx was ineffective; he died from hypernatremia. This reported case emphasises the aggressive course, diagnostic challenges and poor treatment response of cardiac PTCL-NOS.

Learning points: This case represented a significant diagnostic challenge; the clinical problem was documented by multiple imaging modalities, none of which were sufficient to establish a definitive diagnosis.This case is a clear example of how the most challenging cases require a multidisciplinary team, involving professionals from very different specialties (for example cardiologists, cardiac surgeons, general surgeons, haematologists, radiologists, pathologists), to achieve the correct diagnosis and provide the best possible care for the patient.