A Case of Angioimmunoblastic T-Cell Lymphoma

Angioimmunoblastic T-cell Lymphoma (AITL) is a rare type of peripheral T-cell lymphoma characterised by an aggressive clinical course and a poor response to current therapies. There is currently no standard of care for treatment. A case of a 59-year-old male with a history of diabetes mellitus and hypertension presented to the emergency department with chief complaints of intermittent fever, difficulty walking, and generalised weakness. The patient was evaluated for these complaints, and a general examination revealed multiple cervical, axillary, and inguinal lymphadenopathy. Further evaluation with a Positron Emission TomographyComputed Tomography (PET-CT) scan showed Fluorodeoxyglucose (FDG) uptake in the bilateral cervical and supraclavicular lymph nodes. A biopsy of a cervical node revealed sheets of intermediate-sized lymphoid cells, with a few scattered large cells and macrophages, favoring a diagnosis of lymphoma. Further Immunohistochemistry (IHC) was required to determine the final diagnosis. IHC results were positive for CD3, CD2, CD10, PD1, ICOS, CD7, and CD4, which further supported the diagnosis of AITL. The patient was then planned for chemotherapy with the Cyclophosphamide, Adriamycin, Oncovin, and Prednisolone (CHOP) regimen on a 21-day cycle. After four cycles of the CHOP regimen, the patient presented with abdominal distention and bilateral lower limb swelling, requiring multiple blood transfusions due to low haemoglobin levels. Bone marrow biopsy findings suggested hypocellular marrow with atypical lymphoid cells, indicating progression of the disease. The patient was subsequently planned for second-line chemotherapy, considering the patient’s poor performance status, with the single agent Azacitidine. The patient was also advised to undergo Epstein Barr Virus (EBV) testing but was lost to follow-up due to poor performance status.