Spinal Cord Compression due to Pyothorax‐Associated Lymphoma: A Rare Presentation of EBV‐Positive Diffuse Large B‐Cell Lymphoma

Background Pyothorax‐associated lymphoma (PAL) is an Epstein–Barr virus (EBV)–positive diffuse large B‐cell lymphoma developing in the setting of long‐standing chronic pyothorax. Neurological involvement due to spinal invasion is extremely rare. Case Presentation An 87‐year‐old woman with a remote history of pulmonary tuberculosis presented with rapidly progressive paraplegia. Imaging demonstrated chronic right pyothorax with a dorsal epidural mass compressing the spinal cord, continuous with a pleural lesion. A biopsy confirmed EBV‐positive diffuse large B‐cell lymphoma, consistent with PAL. Surgery was considered but declined by the patient and the family. Therefore, the patient was treated with corticosteroids followed by two cycles of R‐CHOP chemotherapy; however, no neurological improvement was observed. Conclusion This case highlights a rare neurological manifestation of PAL. Clinicians should consider lymphoma infiltration in elderly patients with chronic pyothorax who develop new neurological deficits. Early MRI and biopsy are crucial for accurate diagnosis and management.