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Acute T-cell lymphoblastic lymphoma is a rare subtype of non-Hodgkin’s lymphoma accounting for 2% of adult non-Hodgkin’s lymphomas. Cardiac involvement in non-Hodgkin’s lymphoma is usually a late manifestation, and pericardial effusion as an initial presentation is rare. We report a case of acute T-cell lymphoblastic lymphoma in a patient who initially presented with pericardial effusion. Diagnosis was difficult and challenging, as an infectious etiology was first suspected. The patient presented with pericardial effusion without other common clinical manifestations of lymphoma, such as fever, night sweats, and weight loss. He was treated for constrictive pericarditis due to having positive Coxsackie B serology but had no improvement with treatment. The pathology results of the pericardium after pericardiectomy reported fibrosis with a reactive lymphohistiocyte infiltrate. After CT scan revealed a large mediastinal mass, a lymph node biopsy was performed, and T-cell lymphoblastic lymphoma was confirmed. A detailed evaluation to search for occult malignancy should be considered in patients who have persistent pericarditis that is unresponsive to anti-inflammatory therapy and in those who present with a new, large pericardial effusion or cardiac tamponade.

Pericardial effusion and constriction as an initial presentation of acute t-cell lymphoblastic lymphoma