Primary cardiac T-cell lymphoma presenting as ST-elevation myocardial infarction with fatal ventricular arrhythmias: a case report

TL;DR

A rare case of T-cell lymphoma in the heart was mistaken for a heart attack, leading to fatal arrhythmias despite treatment.

Contribution

This case highlights the diagnostic challenges and fatal outcomes of primary cardiac T-cell lymphoma.

Findings

PCTCL can mimic ST-elevation myocardial infarction, complicating diagnosis.

Left ventricular involvement may indicate a fatal stage of the disease.

Multimodality imaging and biopsy are essential for confirming PCTCL.

Abstract

Primary cardiac T-cell lymphoma (PCTCL) is an extremely rare subtype of primary cardiac lymphoma. Due to the paucity of clinical data, it poses a challenge from diagnosis to management.

A 65-year-old female presented with dyspnoea and epigastric pain. Her electrocardiogram revealed an ST-elevation in leads II, III, aVF, and V4–V6, for which she underwent an emergent coronary angiogram, which revealed normal coronaries. Further multimodality cardiac imaging demonstrated a large right ventricular mass infiltrating the inferior wall of the left ventricle. A percutaneous transvenous biopsy was done, and results confirmed an anaplastic T-cell lymphoma, which prompted the initiation of chemotherapy. Unfortunately, her course became more complicated despite a notable reduction in the mass size on follow-up imaging, as she had an incessant, unstable ventricular tachycardia unresponsive to medical therapy, which led to death within 3 months of presentation.

PCTCL has unpredictable presentations. A biopsy is required to reach a definitive diagnosis, alongside multimodality cardiac imaging. Moreover, left ventricular involvement may directly influence survival in PCL and potentially indicate an advanced and fatal stage.

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