ACUTE HYPOXIC RESPIRATORY FAILURE AND DYSPHAGIA SECONDARY TO DIFFUSE LARGE B CELL LYMPOMA OF THE THYROID: A CASE REPORT

SHUJA ABDUL KARIM KHAN; ZHEXIANG HE; SOHAIB Rana; ANASTASIA Almyasheva

doi:10.1016/j.chest.2025.07.1576

INTRODUCTION: Non-Hodgkin lymphoma is the most common hematological malignancy presenting with both nodal and occasionally, extra-nodal manifestations. Primary Thyroid Lymphoma (PTL) is a rare primary site with Diffuse Large B-cell Lymphoma (DLBCL) the most common type. (1) Although rare, its clinical ramifications can be substantial, particularly when it leads to respiratory distress. We present a case of Primary Thyroid DLBCL leading to dysphagia and respiratory distress requiring intubation. CASE PRESENTATION: A 64-year-old male with a history of tobacco abuse, hypothyroidism, and hypertension presented with acute respiratory distress and dysphagia requiring emergent airway intubation. Examination revealed a 9cm neck mass with left-sided tracheal deviation. Subsequent evaluation with CT Chest revealed a large soft tissue neck mass extending to the superior midsternal with mass effect on the trachea causing deviation to the left. Core needle biopsy revealed Diffuse Large B-cell Lymphoma, germinal center type. He was extubated and the plan was for him to receive outpatient chemotherapy, but he became hemodynamically unstable necessitating re-intubation. Bronchoscopy was performed which was unremarkable. Chemotherapy with R-CHOP was initiated leading to rapid improvement in his condition. He tolerated therapy well and he was discharged with instructions to follow-up with oncology to continue ongoing care. DISCUSSION: Diffuse Large B-cell Lymphomas (DLBCL) of the thyroid is a rare extra nodal manifestation which can present with upper airway obstruction and respiratory distress requiring prompt diagnosis and management to prevent life-threatening complications. (2) Core needle biopsy is a vital procedure to procure tissue specimen to confirm histopathology and provide insight into treatment choice. Corticosteroids and Combined chemotherapy regimens are required to control acute symptoms and tumor eradication, respectively. Multidisciplinary approach involving oncologists, otolaryngologists, and critical care specialists is essential for optimal medical management. The first line chemotherapy for DLBCL involves administering a combination of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone, better known as R-CHOP. Incorporating rituximab, a monoclonal antibody that targets CD20 found on B cells, into the CHOP chemotherapy regimen for DLBCL has resulted in significant improvements in patient outcomes. (3) Close monitoring for complications is essential during treatment. CONCLUSIONS: In conclusion, DLBCL involving the thyroid gland can lead to respiratory distress, necessitating urgent intervention. A coordinated approach involving multiple specialties is crucial for timely diagnosis, treatment, and optimal outcomes. Long-term follow-up is necessary to monitor for recurrence and treatment-related complications.

ACUTE HYPOXIC RESPIRATORY FAILURE AND DYSPHAGIA SECONDARY TO DIFFUSE LARGE B CELL LYMPOMA OF THE THYROID: A CASE REPORT

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