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Introduction
Originally described in 1995, primary effusion lymphoma (PEL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL) universally associated with human herpes virus-8 (HHV-8) that involves body cavities and causes serous effusions without detectable masses or lymphadenopathy according to the World Health Organization (WHO) classification of tumors about hematopoietic and lymphoid tissue [1-4]. It occurs mainly in immunocompromised patients infected with human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) [2, 4, 5]. On the other hand, in Japan, many cases of DLBCL with lymphomatous effusions on serosal surfaces and no detectable mass lesion like PEL have been reported. These cases were not regarded as cases of PEL but as a new entity, “PEL-like lymphoma (PEL-LL)” [6].
Herein, we report a case of an elderly female patient with DLBCL with bilateral pleural effusion and massive pericardial effusion. The type of DLBCL was difficult to determine because clinical features and several findings of examinations resembled PEL or PEL-LL; however, the patient’s hematological findings could not be diagnosed as both.
Case Report
A 93-year-old female was transferred to the emergency ward of our hospital due to disturbance of consciousness and hypotension. Her medical history included gastric tube feeding due to cerebral infarction and disuse syndrome, complicated by hypertension, atrial fibrillation, chronic renal insufficiency, and constipation. She was under treatment with antiplatelet, antihypertensive, and cathartic medications. She had been bedridden for a number of years and had received regular medical and nursing care at home. When the ambulance call to render medical assistance arrived at her home, she had fully recovered her consciousness, her blood pressure was within normal limits, and she did not complain of B symptoms.
In the emergency room, she presented with mild disturbance of consciousness (Japan coma scale 1), irregular pulse rate, and mild pitting edema to bilateral lower legs. She was negative for lymphadenopathy and hepatosplenomegaly. Urinalysis showed asymptomatic bacteriuria, and routine blood tests showed normocytic anemia, hypoalbuminemia, and several chemical data such as C-reactive protein, lactate dehydrogenase, creatinine, blood urea nitrogen, potassium, ferritin, and soluble interleukin-2 receptor were elevated. Electrocardiogram showed atrial fibrillation, and carotid ultrasonography showed moderate arteriosclerosis. Computed tomography of her head, neck, chest, and abdomen showed multiple lacunar infarction, bilateral pleural effusion, pericardial effusion, and bilateral renal atrophy....