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Diffuse large B cell lymphoma with superimposed lung abscess: potential role for intracavitary fibrinolytic therapy through a percutaneous drain to facilitate lung abscess drainage
  1. June Chae,
  2. Ryan Kern,
  3. Darlene Nelson and
  4. John Mullon
  1. Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr John Mullon, Mullon.John{at}


This is a case of primary pulmonary lymphoma presenting concurrently with superimposed lung abscess, managed with the assistance of intracavitary fibrinolytic therapy. A 28-year-old man presented with 2 months of persistent cough. He had a large lung abscess involving almost the entire right upper lobe. The mass continued to progress in spite of appropriate antibiotic administration. Given the extent of involvement, he was not a surgical candidate. A bronchoscopy with bronchoalveolar lavage and transbronchial biopsies demonstrated diffuse large B cell lymphoma. Initial cultures were positive for Group G Streptococci. A CT-guided percutaneous drain was placed with initial purulent drainage that grew Prevotella and Streptococcus mitis; however, drainage quickly abated without adequate evacuation of the abscess cavity. To further optimise drainage in anticipation of chemotherapy administration, intracavitary fibrinolytic therapy including tissue plasminogen activator and deoxyribonuclease was attempted to better evacuate the infected space.

  • infectious diseases
  • oncology
  • pharmacology and therapeutics
  • respiratory medicine

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  • Contributors JC, JM and RK were instrumental in contributing to the planning, design, conception and interpretation of the data for this case report. DN helped with conception of the case report and acquisition of data. All contributed to the conceptualisation of this case as well as to the drafting and critical revision of the report. All authors mentioned above have given their final approval of this version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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