Key result
Occult peripheral T-cell lymphoma presents as fulminant heart failure and conduction disease without lymphadenopathy.
Why the study?
Peripheral T-cell lymphoma, not otherwise specified, is a rare and aggressive subtype of non-Hodgkin lymphoma where extensive infiltration without lymphadenopathy is rare.
Case Report (n=1)
This case highlights that peripheral T-cell lymphoma can present as isolated progressive cardiomyopathy and conduction disease without lymphadenopathy, emphasizing the critical diagnostic role of endomyocardial biopsy.
Consider occult lymphoma in unexplained HF with conduction disease despite absent lymphadenopathy; leaves open whether endomyocardial biopsy enables timely antemortem diagnosis.
BACKGROUND: Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), is a rare, aggressive subtype of non-Hodgkin lymphoma with no defining immunophenotypic or genetic signature. Extranodal involvement is common, but extensive infiltration without lymphadenopathy is rare. CASE SUMMARY: A 69-year-old man presented with progressive cardiomyopathy and conduction disease, without systemic symptoms or imaging evidence of malignancy. Workup revealed an atypical T-cell infiltrate on endomyocardial biopsy, but peripheral blood flow cytometry and imaging were unrevealing. Diagnosis remained uncertain during life. DISCUSSION: The patient rapidly deteriorated and died. Autopsy revealed diffuse T-cell infiltration in the heart, kidneys, and adrenal gland. Immunohistochemistry was suspicious for lymphoma. Despite biopsy findings, incomplete staging and lack of definitive clonal markers delayed diagnosis. Final diagnosis of PTCL-NOS was made. TAKE-HOME MESSAGES: This case presents cardiac-predominant PTCL-NOS with multiorgan infiltration and no lymphadenopathy. In cases of unexplained cardiomyopathy, endomyocardial biopsy is critical, and malignancy must be considered, even without systemic signs.
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Memon et al. (2025) conducted a case report in Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) (n=1). Peripheral T-cell lymphoma, not otherwise specified was evaluated. In a patient presenting with unexplained new-onset heart failure and conduction disease, autopsy and endomyocardial biopsy revealed extensive multiorgan peripheral T-cell lymphoma without lymphadenopathy.
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