Complete regression of myocardial involvement associated with lymphoma following chemotherapy
Juan Pablo Vinicki1, Tomás F Cianciulli, Gustavo A Farace
1Juan Pablo Vinicki, Gustavo A Farace, Adolfo Wachs, Department of Internal Medicine, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, C1155AHD, Argentina.
Insights
This case report details a rare instance of T-cell lymphoblastic lymphoma (T-LBL) presenting with cardiac, testicular, and facial nerve involvement. Intensive chemotherapy led to complete regression of myocardial infiltration, highlighting treatment efficacy for this rare presentation.
Area of Science:
- Oncology
- Cardiology
- Neurology
Background:
- Malignant lymphoma rarely presents initially with cardiac involvement.
- Cardiac manifestations in lymphoma can include myocardial infiltration, pericardial effusion, and conduction abnormalities.
- Testicular masses and peripheral facial paralysis are uncommon initial symptoms of lymphoma.
Purpose of the Study:
- To report a unique case of T-cell lymphoblastic lymphoma (T-LBL) with initial presentation of myocardial infiltration, testicular mass, and unilateral peripheral facial paralysis.
- To demonstrate the effectiveness of chemotherapy in achieving regression of cardiac infiltration in this rare lymphoma presentation.
Main Methods:
- Case report of a 26-year-old male with initial diagnosis of myocardial infiltration via echocardiogram.
- Diagnostic workup included electrocardiograms (ECG), two-dimensional echocardiography, and axillary lymph node biopsy.
- Treatment involved chemotherapy following diagnosis and staging.
Main Results:
- The patient was diagnosed with T-cell lymphoblastic lymphoma (T-LBL).
- Initial ECG showed significant abnormalities including negative T-waves and ST-segment elevation.
- Echocardiography revealed pericardial infiltration, aortic wall thickening, atrial involvement, and depressed ventricular function.
- Following chemotherapy, ECG and echocardiography demonstrated complete regression of cardiac infiltration and normalization of ECG findings.
Conclusions:
- T-cell lymphoblastic lymphoma can present with a rare combination of testicular mass, peripheral facial paralysis, and myocardial involvement.
- Intensive chemotherapy is effective in achieving complete regression of cardiac infiltration in T-LBL.
- This case highlights the importance of considering lymphoma in patients with unexplained cardiac and neurological symptoms.
Abstract:
Cardiac involvement as an initial presentation of malignant lymphoma is a rare occurrence. We describe the case of a 26 year old man who had initially been diagnosed with myocardial infiltration on an echocardiogram, presenting with a testicular mass and unilateral peripheral facial paralysis. On admission, electrocardiograms (ECG) revealed negative T-waves in all leads and ST-segment elevation in the inferior leads. On two-dimensional echocardiography, there was infiltration of the pericardium with mild effusion, infiltrative thickening of the aortic walls, both atria and the interatrial septum and a mildly depressed systolic function of both ventricles. An axillary biopsy was performed and reported as a T-cell lymphoblastic lymphoma (T-LBL). Following the diagnosis and staging, chemotherapy was started. Twenty-two days after finishing the first cycle of chemotherapy, the ECG showed regression of T-wave changes in all leads and normalization of the ST-segment elevation in the inferior leads. A follow-up Two-dimensional echocardiography confirmed regression of the myocardial infiltration. This case report illustrates a lymphoma presenting with testicular mass, unilateral peripheral facial paralysis and myocardial involvement, and demonstrates that regression of infiltration can be achieved by intensive chemotherapy treatment. To our knowledge, there are no reported cases of T-LBL presenting as a testicular mass and unilateral peripheral facial paralysis, with complete regression of myocardial involvement.
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