Key result
Chemotherapy yields transient hemodynamic improvement in primary cardiac lymphoma before fatal septic shock.
Why the study?
The management of critically ill patients with primary cardiac lymphoma presenting with obstructive shock is complex and poorly described, with no established guidelines.
Case Report (n=1)
In critically ill patients presenting with primary cardiac lymphoma complicated by obstructive shock, chemotherapy can provide initial hemodynamic improvement without the need for high-risk cardiac surgery, though infection risk remains a severe threat.
Chemotherapy may yield transient stabilization in cardiac lymphoma shock; leaves open strategies to avert fatal sepsis.
BACKGROUND: The medico-surgical management of cardiac tumors when there is a suspicion of malignancy is complex. Moreover, in a critically ill setting, the choice of diagnostic tools seems crucial. CASE PRESENTATION: We present the case of a sixty-four-year-old patient with no prior medical history who was admitted to the intensive care unit with obstructive shock secondary to a right heart mass and pulmonary embolism. Clinical and biological features revealed secondary hemophagocytic lympho-histiocytosis (HLH). The patient underwent a diagnostic procedure with dual thoracoscopic and mediastinoscopy with biopsies. Following the diagnosis of primary cardiac lymphoma, the patient received sequential chemotherapy without undergoing cardiac surgery leading to initial improvement, with reductions in intracardiac obstruction and in biomarkers associated with hemophagocytic lympho-histiocytosis. CONCLUSION: When a cardiac mass is associated with extracardiac symptoms indicative of a hematological malignancy, the preferred treatment is chemotherapy, and cardiac surgery should be avoided.
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Ottavy et al. (2025) conducted a case report in Primary cardiac lymphoma with obstructive shock and hemophagocytic lympho-histiocytosis (n=1). Chemotherapy and diagnostic endoscopic thoracic procedures was evaluated. In a 64-year-old patient with primary cardiac lymphoma and obstructive shock, sequential chemotherapy led to initial hemodynamic improvement, though the patient ultimately died of refractory septic shock 6 weeks later.
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