Primary pulmonary lymphomas mimicking pulmonary tuberculosis in a 56 year old male in Calabar, South-South Nigeria

Abstract

Background: Primary pulmonary lymphomas are rarely taken into consideration in the differential diagnosis of lung lesions especially in pulmonary tuberculosis endemic region like Nigeria.
Aim: The aim of this report is to awaken our consciousness on the dilemma in diagnosis of primary pulmonary lymphoma in a low resource setting.
Case Report: We present the case of a 56-year old man who was admitted to the hospital with a history of coughing, fever, fatigue and right pleural effusion. He was managed as case of pulmonary tuberculosis in a peripheral centre with no improvement and later referred to our facility. Gene Xpert was negative.
Results: The patient had a thoracotomy with bilobectomy of the right upper and middle lung lobe on account of destroyed lung syndrome secondary to pulmonary tuberculosis. Following histological examination, primary pulmonary lymphoma was diagnosed. Immunohistochemistry positive for CD45, CD20, CD3 and negative for Desmin, Synaptophysin. Open lung biopsy was performed and Primary pulmonary lymphoma was finally diagnosed. The patient under-went chemotherapy and showed a significant improvement.
Conclusions: Primary Pulmonary lymphoma is a rare disease and displays a slow and mild course with a good prognosis. A proper diagnosis can only be established by a histopathological examination.