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Peripheral T-cell lymphoma presenting as fever of unknown origin in a man with deranged liver function tests and pancytopenia
  1. Catharine McKay1,
  2. Lin-Tse Hong2 and
  3. A K M Nizam Uddin3,4
  1. 1Medicine, Central Gippsland Health Service, Sale, Victoria, Australia
  2. 2Medicine Department, Central Gippsland Health Service, Sale, Victoria, Australia
  3. 3Monash Lung & Sleep, Central Gippsland Health Service, Sale, Victoria, Australia
  4. 4Lung & Sleep, Monash Medical Centre Clayton, Clayton, Victoria, Australia
  1. Correspondence to Dr A K M Nizam Uddin; akmnizam{at}gmail.com

Abstract

Peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is a relatively rare condition in Australia. Here, we report a case of PTCL, NOS in a patient who presented with persistent fever and progressive pancytopenia on a background of mediastinal lymphadenopathy, initially presumed reactive and hepatosplenomegaly with deranged liver function tests. The diagnosis was challenging, with multiple negative blood cultures and inconclusive bone marrow studies, and it required extensive investigations that ultimately revealed the characteristic clinical, histopathological and immunophenotypic features of PTCL, NOS. The patient underwent multiple rounds of multiagent chemotherapy after the diagnosis. This case highlights the difficulty in diagnosing PTCL, NOS and the importance of including it as a differential diagnosis in younger patients who present with constitutional symptoms and hepatosplenomegaly.

  • haematology (incl blood transfusion)
  • medical education
  • screening (oncology)
  • pathology

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Footnotes

  • Contributors AKMNU personally giving thanks to Medicine, Radiology and Pathology department of Central Gippsland Health for their valuable support and also the Histopathologist from St,Vincent’s Hospital, Melbourne for their valuable contribution for this case study. CM and L-TH,write up the case and as a senior consultant, I have to supervise the whole process.

  • 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 for publication Obtained.

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

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