Primary effusion lymphoma presenting as dyspnoea and chronic cardiac tamponade: a case report
Introduction (case reports only) Primary effusion lymphoma (PEL) is a rare disease that usually presents as effusion in pleural, peritoneal, and pericardial spaces. It is frequently found in patients positive for HIV, or immunodeficient due to other causes. Case description (case reports only) A 75-year-old woman with a history of arterial hypertension, chronic atrial fibrillation and type 2 diabetes was treated in a regional hospital for acute pneumonia and heart failure. Due to progressive dyspnoea, echocardiography was performed and 19 mm of pericardial fluid (pf) was found. The patient was hospitalised to the cardiology department of the hospital of Lithuanian University of Health Sciences Kauno Klinikos. Chronic cardiac tamponade was suspected, 1,4 litres of bloody pf was obtained by pericardiocentesis. PF cytology did not show neoplastic cells. Pulmonary hypertension was observed during echocardiography, but pulmonary embolism was rejected by chest ct. Because of progressing dyspnoea, hydrothorax and hypotension, the patient was admitted to the ICU where more than 4 litres of pleural fluid was obtained by pleurocentesis. After three days, dyspnoea decreased and the patient was transferred back to the cardiology department. Thoracic, abdominal and pelvic CT showed decreased hydrothorax and no other significant pathologies. Pleural fluid cytology did not show neoplastic cells, analysis with the cell block technique revealed large b-cell lymphoma. A repeated echocardiography showed normal left ventricle function and no pericardial effusion. Later the patient was transferred to the Haematology Department for further treatment. Summary (case reports only) A 75-year-old woman was hospitalised due to acute pneumonia and heart failure. Pericardial and pleural effusion was diagnosed and after rejecting other typical causes, pleural fluid analysis showed large b-cell lymphoma. Conclusions Pericardial effusion is usually associated with viral infection and mostly affects men ages 20 to 50 years. It is important to consider rare and oncological diseases in case of pericardial and pleural effusion with unknown aetiology.