Abstract
SESSION TITLE: Pulmonary Manifestations of Systemic Disease 4 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: ALK positive T cell lymphoma is aggressive albeit chemotherapy responsive. It presents in 0.25 cases per 100,000 people with a 2:1 male to female ratio. It rarely metastasizes to the lungs, and may present with several radiographic findings including a single mass, a nodule with halo sign, bronchovascular distribution, and diffuse reticulation. Early diagnosis and treatment is imperative as the disease can cause respiratory failure. CASE PRESENTATION: 26 year old in excellent health deployed to the Middle East developed an upper respiratory tract infection with axillary adenopathy. Despite two weeks of treatment, he did not improve. X-ray revealed pneumonia. Antibiotics were initiated for persistent fevers and leukocytosis. He was sent to Germany where computed tomography scan revealed diffuse patchy alveolar opacities. Hypoxemia ensued, he was intubated and flown to Walter Reed. Treatment escalated for fungal and viral coverage. Bronchoscopy was performed and bronchoalveolar lavage revealed no infectious culprits. Persistent leukocytosis and lack of resolution provided impetus to obtain axillary lymph node biopsy which revealed grade IV anaplastic Large Cell T-cell lymphoma (ACLC). Chemotherapy provided rapid improvement. DISCUSSION: ACLC metastasis to the lung is a rare clinical entity with only three reported cases. Unfortunately, in these cases the diagnosis was only found post mortem. This case was successful because of the multiple opportunities to readdress the etiology at different levels of care. Prior to diagnosis he was had no improvement of hypoxemia or leukocytosis on broad spectrum antimicrobial therapy. Upon arrival to Walter Reed the differential was challenged to include lymphoma which was vindicated on biopsy. He is radiographically cancer free seventeen months after diagnosis and chemotherapy. CONCLUSIONS: Reassessment of the anchored diagnosis and rapid transfer over 6,500 miles allowed this patient a chance for rapid treatment with quick clinical improvement. Despite the high rate of complete response of this cancer, if missed the outcome appears to be universally fatal. Reference #1: S Ondrejka, DO, et. al. T-cell Lymphomas Updates in Biology and Diagnosis Lung 2015; Surgical Pathology Clinics Reference #2: T Ueda, MD, et. al. Diffuse Pulmonary Involvement by Mycosis Fungoides: High-Resolution Computed Tomography and Pathologic Findings Journal of Thoracic Imaging Reference #3: C Boland, Relapsing T-cell Lymphoma Mimicking Adult Respiratory Distress Syndrome and Sepsis; Leukemia & Lymphoma DISCLOSURE: The following authors have nothing to disclose: Michael Switzer, Paul Clark No Product/Research Disclosure Information
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