Primary pulmonary T-cell lymphoma mimicking asthma and community-acquired pneumonia: a rare case report

Primary pulmonary T-cell lymphoma (PPTL) is a rare disease. Diagnosing PPTL is challenging due to non-specific clinical symptoms and imaging. A 32-year-old female presented with persistent fever, cough, and dyspnoea. The symptoms were initially treated as asthma and community-acquired pneumonia without improvement. Chest computed tomography (CT) revealed bilateral consolidations with a CT angiogram sign, and flexible bronchoscopy showed infiltrative lesions causing bronchial stenosis. Histopathological examination of the tissue biopsy identified T-cell lymphoma through immunohistochemical staining positive for CD3. This case highlights the importance of considering differential diagnoses such as PPTL in patients with atypical presentations of asthma or non-resolving pneumonia. This case also demonstrates the diagnostic utility of flexible bronchoscopy in identifying airway obstruction due to malignant cells, which can mimic asthma. LEARNING POINTS: Primary pulmonary T-cell lymphoma can manifest as atypical asthma and non-resolving pneumonia, making early diagnosis challenging.Malignant aetiologies, including primary pulmonary T-cell lymphoma, should be considered in cases of bilateral consolidations that do not respond to antibiotics and present CT angiogram signs.Histopathology remains the gold standard in primary pulmonary T-cell lymphoma diagnosis, wherein flexible bronchoscopy should be employed as a minimally invasive first-line approach for tissue biopsy.