From Tachycardia to Lymphoma: A Case Report of CD30 Positive (ALK) T-Cell Lymphoma Initially Presenting with Cardiac Envolvement

Case Report

Austin Cardio & Cardiovasc Case Rep. 2023; 8(4): 1064.

From Tachycardia to Lymphoma: A Case Report of CD30 Positive (ALK) T-Cell Lymphoma Initially Presenting with Cardiac Envolvement

Mohammed Al Thawabta, MD; Mutaz Karameh, MD; Mordechai Golomb, MD; OrenYagel, MD*

Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

*Corresponding author: Oren Yagel Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Ein Karem, POB 12000, Jerusalem 9112001, Israel. Tel: +972526105699 Email: oreny@hadassah.org.il

Received: October 24, 2023 Accepted: November 20, 2023 Published: November 27, 2023

Abstract

Anaplastic Large Cell Lymphoma (ALCL), Anaplastic Lymphoma Kinase-Positive (ALK+), is a rare subtype of large cell lymphoma. Cardiac involvement as the initial presentation leading to diagnosis is extremely rare. We present a young patient with atrial tachycardia as the presenting manifastation of ALCL.

Keywords: Anaplastic large cell lymphoma; ALK-positive; CD30; Interatrial septum hypertrophy; Atrial tachycardia

Abbreviations: ALCL: Anaplastic Large Cell Lymphoma; ALK+: Anaplastic Lymphoma Kinase-Positive; PET-FDG: Positron Emission Tomography Fluorodeoxyglucose; CT: Computed Tomography; CHP BV: Cyclophosphamide + Doxorubicin + Prednisone + Brentuximab + Vedotin

Background

ALCL-ALK+, a rare subtype of large cell lymphoma, are a CD30-positive neoplasm accounting for 2% to 8% of all lymphomas. It is characterized by the proliferation of predominantly large lymphoid cells and high expression of the cytokine receptor CD30 [1]. It is caused by chromosomal translocations involving the ALK gene. No potential predisposing factors have been reported [2]. Symptomatic involvement of the cardiovascular system is an uncommon entity [4]. Cardiac involvement as the initial presentation is extremely rare.

We report a unique case of CD30 positive T-cell lymphoma initially presenting with atrial tachycardia

Case Presentation

A 22-year-old male patient with no significant past medical history presented to our hospital due to palpitations.

A few weeks prior to his admission, the patient noted mild neck swelling and swallowing difficulty. He denied fever, night sweats, dizziness, or syncope. Of note, the patient was on a new dietary program with an intentional weight loss of 10 kg over two months.

On admission, his heart rate was 140 BPM, hemodynamically stable and afebrile. Physical examination revealed diffuse neck swelling and palpable supraclavicular mass and diffuse jugular lymph nodes enlargement, more prominent on the left. Cardiac auscultation was unremarkable. Electrocardiogram demonstrated narrow complex tachycardia of 140 BPM, suggestive of atrial tachycardia with no ST-T changes of acute ischemia (Figure 1). Laboratory workup was notable for elevated LDH. Other labs, including CBC, blood chemistry, Troponin, and CPK levels were within the normal limits.