A Rare Case of Aggressive Peripheral T-cell Lymphoma-Not Otherwise Specified

Peripheral T-cell lymphomas are an offshoot of non-Hodgkin's lymphomas and usually carry a poor prognosis. Their clinical manifestations could be very variable and can mimic an infectious or autoimmune etiology. Here, we present a case of a 58-year-old healthy female who presented with fever, cough, and shortness of breath for several days. Imaging studies including chest x-ray and CT scans were suggestive of pleural effusions, mediastinal/retroperitoneal lymphadenopathy, and splenomegaly. She was initially managed for severe sepsis in the setting of possible community-acquired pneumonia. Later her course of hospitalization was complicated by respiratory failure and needing mechanical ventilation and then extracorporeal membrane oxygenation (ECMO). Multiple biopsies were performed including bone marrow and lymph nodes which were suggestive of peripheral T-cell lymphoma - not otherwise specified. Due to the severity of her illness, palliative discussions were made and the family opted for comfort care.