Atrial fibrillation and acute respiratory failure: unique presentation of diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma is the most common lymphoid neoplasm, accounting for approximately 25% of all non-Hodgkin lymphomas. Patients typically present with nodal enlargement, fever, weight loss, or night sweats. Extranodal extramedullary disease occurs in up to 40% of cases with the most common site of extranodal involvement being the gastrointestinal tract. However, diffuse large B-cell lymphoma can present in virtually any area, including the testes, bones, thyroid, salivary glands, tonsils, skin, liver, breasts, adrenals, kidneys, nasal cavity, paranasal sinuses, cervix, and central nervous system.

We present a unique case of atrial fibrillation and respiratory failure as an initial presentation of diffuse large B-cell lymphoma with cardiac and cavitary pulmonary involvement.

The recent advances in chemotherapeutic options allow for and reinforce the importance of tailoring the chemotherapy regimen to the individual patient's unique presentation. In our patient, presentation included extensive intracardiac involvement resulting in arrhythmias, cavitary pulmonary nodules, and acute hypoxemic respiratory failure requiring ventilator support.