A man in his forties with increasing shortness of breath

Diffuse large B-cell lymphoma is an aggressive non-Hodgkin lymphoma. The patients are often critically ill with a variety of symptoms, but the disease is potentially curable.

A previously healthy man in his forties was admitted to the local hospital feeling unwell, with dyspnoea, cough, fever and weight loss. The clinical examination was normal. Lactate dehydrogenase and sedimentation rate were elevated. Blood smear and bone marrow biopsy were normal. In the weeks that followed, the patient became critically ill with respiratory failure, exhaustion and continuous fever. Computed tomography (CT) scan revealed diffuse lung infiltrates in addition to hepatosplenomegaly. High levels of ferritin, triglycerides and soluble interleukin-2 receptor were also found. Haemophagocytic lymphohistiocytosis was suspected, and the patient was admitted to the intensive care unit. Biopsies confirmed diffuse large B-cell lymphoma, and treatment was started immediately.

The clinical manifestations of lymphoma are diverse. In this case report the suspicion of haemophagocytic lymphohistiocytosis led to a thorough search for a malignant disease, primarily lymphoma. Patients with diffuse large B-cell lymphoma are often critically ill, deteriorating rapidly. Histological verification of the diagnosis and immediate start of treatment are essential for the outcome.