Primary Pulmonary Lymphoma Presenting as the Lung Abscess: A Case Report

Introduction: The common presentations of primary pulmonary lymphoma are a lung mass and small nodules.

Objective: To describe a case of primary pulmonary lymphoma who was initially diagnosed and treated as the lung abscess.

Case Presentation: A 58-year-old Thai man presented with chronic cough and low-graded fever with weight loss for 10 kg in three months. The physical examination revealed only occasional wheezing at left lung. The blood tests included Hb 9.2 g%, WBC 5,600/mm3, platelet 349,000/mm3, FBS 237 mg%, LDH 390 U/L, HIV antibody – negative, CA-125 131.3 U/ml, CA19-9 13,538.4 U/ml, broncho-alveolar lavage- no AFB, no malignancy, sputum culture- no growth. The chest film and the computerized tomography of the chest showed one large cavitary lesion with air-fluid level at left lower lung field, 9.7x8.8 cm, lung abscess was likely. The lung biopsy via the bronchoscopy showed only chronic inflammation. He was treated with meropenem for 5 weeks, glipizide, and metforminand postural drainage without the clinical improvement. Left lung pneumonectomy was performed, an8-cm lung mass showed malignant lymphoma, diffuse large B cell. With the rituximab and CHOP therapy, he was in complete remission for four years. Then he came again with chronic fatigue for a few months due to marked pallor, and splenomegaly 3 fingerbreadths. The blood tests showed: Hb 5.5 g%, WBC 17,210/mm3, platelet 66,000/mm3, N 20.0%, L 74.0%, direct anti-globulin tests-positive 1+. His new diagnoses were chronic lymphocytic leukemia and Evans’ syndrome andhe was treated with dexamethasone, cyclophosphamide and blood transfusion.

Conclusion: In case of lung abscess with poor response to antibiotics, the surgical intervention should be considered, not only for the therapeutic purpose but also for the adequate tissue for pathological diagnosis.

Keywords: Primary pulmonary lymphoma, Lung abscess, Surgical intervention.