JEYARAMAN SAI PRITAM,D. KANIMOZHI,DR SARANYA PALANISWAMY,R KANNAN
DOI: https://doi.org/Non-Hodgkin’s Lymphoma (NHL) encompasses a broad spectrum of lymphoid malignancies, with varied presentations depending on the histological subtype and extent of disease. Diffuse Large B-Cell Lymphoma (DLBCL), the most common and aggressive form of NHL, often presents with rapidly enlarging lymphadenopathy, but may also mimic chronic infections or inflammatory conditions, leading to delayed diagnosis. We report the case of a 41-year-old female with no known comorbidities who presented with intermittent fever and progressive left axillary and inguinal lymphadenopathy over a six-month period. Despite initial symptomatic improvement with antibiotics and a non-diagnostic lymph node biopsy, the patient continued to experience worsening symptoms, including lower limb swelling and newly developed cervical swelling with dysphagia. On examination, right tonsillar hypertrophy was noted. CT imaging revealed a well-defined mass involving the oropharynx and tonsil, with extensive cervical lymphadenopathy and compression of adjacent vascular structures. CT venogram of the lower limbs showed significant lymphadenopathy in the iliac and inguinal regions, causing compression of the left iliac vein, but no evidence of thrombosis. Histopathological analysis of a right tonsillectomy specimen demonstrated features consistent with high-grade lymphoma. Immunohistochemistry confirmed Diffuse Large B-Cell Lymphoma (DLBCL), non-germinal center subtype. The patient was staged as Ann Arbor Stage 3B and initiated on R-CHOP chemotherapy, completing five cycles with ongoing follow-up.
This case shows the diagnostic complexity of NHL, particularly when early symptoms overlap with more common infectious or inflammatory conditions. Persistent lymphadenopathy, non-responsiveness to empirical treatment, and evolving systemic features warrant thorough re-evaluation with appropriate imaging and biopsy. Extranodal involvement, especially of the tonsils, should raise suspicion for lymphoma in the right clinical context. Prompt diagnosis and immunophenotyping are crucial for timely initiation of therapy, especially in aggressive subtypes like DLBCL.
