Key result
A 46-year-old immunosuppressed woman presented with a large pericardial effusion and cardiac tamponade as a rare initial manifestation of disseminated diffuse large B cell lymphoma, which proved refractory to R-CHOP chemotherapy.
Case Report (n=1)
No
This case highlights that pericardial effusion can be a rare initial presentation of disseminated non-Hodgkin's lymphoma in immunosuppressed patients, which may be refractory to conventional chemotherapy and complicated by myocardial infiltration and conduction block.
Answers are grounded in this paper and cite their sources.
Consider lymphoma in immunosuppressed patients with tamponade; extends DLBCL presentations but leaves optimal management open.
A 46-year-old woman with quiescent lupus presented with worsening pleuritic chest pain and dyspnoea. Bedside echocardiogram confirmed large pericardial effusion with cardiac tamponade. Emergency bedside pericardiocentesis was performed. Pericardial fluid cytology confirmed diffuse large B cell lymphoma, stage four on positron emission tomography. Conventional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy achieved good response in all sites except the pericardium. Progressive cardiac involvement was complicated by atrioventricular conduction block requiring permanent pacemaker. Second-line palliative chemotherapy was performed.
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Giudicatti et al. (2018) conducted a case report in Disseminated non-Hodgkin's lymphoma (n=1). R-CHOP chemotherapy was evaluated. A 46-year-old immunosuppressed woman presented with a large pericardial effusion and cardiac tamponade as a rare initial manifestation of disseminated diffuse large B cell lymphoma, which proved refractory to R-CHOP chemotherapy.
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