Intracardiac diffuse large B-cell lymphoma in a 59-year-old man presented atypically as a chronic cough, highlighting the need for imaging when cough is refractory to typical therapies.
Case Report (n=1)
Intracardiac diffuse large B-cell lymphoma can present atypically with chronic cough due to mass effect, underscoring the importance of multimodality imaging when symptoms are refractory to standard therapies.
Abstract Introduction Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL), accounting for approximately 25% of cases. Cardiac involvement is rarer and typically presents with nonspecific symptoms. We present a case of lymphoma with cardiac involvement presenting as chronic cough. Case Presentation A 59 year old man was referred to pulmonary medicine for a 4 month history of dry cough. The cough had been refractory to antibiotics, steroids, proton pump inhibitors, nasal corticosteroids, and benzonatate. The patient also reported a 15 pound weight loss and fatigue. The patient smoked cigars daily until one month prior to presentation. He underwent a chest computed tomography (CT) with intravenous contrast revealing a large left atrial tumor extending into the right lower lobe veins. The patient was admitted to the hospital for expedited evaluation. Cardiac magnetic resonance imaging (MRI) redemonstrated a lobulated left atrial mass and an additional right atrial mass concerning for malignancy. Positron emission tomography (PET) revealed scattered fluorodeoxyglucose (FDG) avid mediastinal and abdominal lymph nodes and numerous hypermetabolic masses in the spleen, right and left atrium. Given suspicion for NHL, he underwent endobronchial and endoscopic ultrasound-guided needle aspiration biopsy of a mediastinal and perisplenic lymph node. Histopathology confirmed the diagnosis of germinal center B-cell-like DLBCL. The patient promptly began chemotherapy with EPOCH (etoposide, prednisone, cyclophosphamide, vincristine, and doxorubicin) without complications. DISCUSSION DLBCL is an aggressive malignancy that most commonly presents with dyspnea (28%), painless swelling (28%), weight loss (22%), night sweats (23%), and cough (11%). Large, space-occupying intracardiac DLBCL may present with chronic cough due to irritation of the vagal afferents of the upper airways from mass effect. These patients pose a unique diagnostic challenge as their symptoms can mimic common cough syndromes such as gastroesophageal reflux disease, upper airway cough syndrome, or asthma. Contrast chest CT can help identify intracardiac DLBCL, while cardiac MRI can further differentiate a neoplasm from myxoma, vegetations, and thrombi. Biopsy is required for definitive diagnosis. Conclusion Early recognition of DLBCL is crucial given favorable prognosis with treatment. Although most cases of chronic cough have a benign etiology, prompt use of imaging is necessary when other worrisome symptoms are present, or when the cough fails to respond to typical therapy. In our case, chronic cough was the primary symptoms of DLBCL with cardiac involvement, highlighting the importance of maintaining a broad differential when evaluating a chronic cough. This abstract is funded by: None
Garcia et al. (2026) conducted a case report in Intracardiac Diffuse Large B-cell Lymphoma (n=1). EPOCH chemotherapy was evaluated. Intracardiac diffuse large B-cell lymphoma in a 59-year-old man presented atypically as a chronic cough, highlighting the need for imaging when cough is refractory to typical therapies.