A 29-year-old immunocompetent man presenting with pleuritic chest pain was diagnosed with primary pulmonary follicular lymphoma, an unusual presentation mimicking chronic infection.
Case Report (n=1)
Primary pulmonary lymphoma should be considered in the differential diagnosis of multiple lung consolidations even in young, immunocompetent patients.
Abstract Primary pulmonary lymphoma (PPL) is defined as a lymphoma involving the lung parenchyma and/or bronchi, with or without mediastinal involvement, and no evidence of extrathoracic disease at diagnosis or within 3 months thereafter. PPL is rare, approximately less than 1% of primary lung malignancies and extranodal lymphomas. Here, we report a case of primary pulmonary follicular lymphoma, an uncommon subtype of PPL. A 29-year-old Thai man presented with 2-month history of intermittent pleuritic chest pain without other chest or systemic symptoms. He was initially treated as pneumonia with amoxicillin-clavulanate and roxithromycin, without improvement. He had no underlying diseases, was not taking any medications, and denied substance use or tuberculosis contact. Physical examination was unremarkable. Laboratory showed a normal complete blood count, anti-HIV and serum galactomannan were negative. Chest radiography revealed bilateral alveolar infiltrations, predominantly in both lower lungs. Chest CT demonstrated multifocal consolidations with ground-glass opacities, scattered peripheral and lower-lobe distribution, centrilobular nodules with tree-in-bud pattern, and multiple paratracheal, para-aortic and mediastinal lymphadenopathies. Flexible bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBX) was performed. Cultures for bacteria, tuberculosis, fungi and BAL galactomannan were negative. Pathology showed atypical B-cell lymphoproliferation positive for CD20, CD10, BCL2, BCL6, and CD10, with AE1/AE3 and TTF1 highlighting reactive pneumocytes, and negative for AFB and GMS stains. These findings were consistent with follicular lymphoma. Staging work-up, including CT of the whole abdomen and bone marrow examination, showed no systemic involvement, confirming primary pulomonary lymphoma. PPL can present with nonspecific symptoms such as cough (50%), dyspnea (40%), and pleuritic chest pain (17%), with or without B symptoms, and some patients remain asymptomatic. Radiographic findings vary, including mass, nodules, or consolidations (22%), which may be solitary or multiple, with or without lymphadenopathy. The differential diagnosis in immunocompetent hosts with multiple lung consolidations includes chronic infections such as tuberculosis and fungal infections, as well as malignancies including hematologic lymphoma, primary lung cancer, and Kaposi sarcoma. In our case, the patient’s young age, immunocompetent status, and CT findings initially suggested infection as the most likely diagnosis.This case highlights the diagnostic challenge of primary pulmonary lymphoma, which often mimics chronic infection, autoimmune or other malignancies. While most reported cases occur in older (60-70 decades of life) and immunocompromised patients, our patients was young and no immunosuppressive status- an unusual presentaion that emphasizes the broad spectrum of PPL. This abstract is funded by: none
Luepiyapanich et al. (Fri,) conducted a case report in Primary pulmonary follicular lymphoma (n=1). A 29-year-old immunocompetent man presenting with pleuritic chest pain was diagnosed with primary pulmonary follicular lymphoma, an unusual presentation mimicking chronic infection.