Pyothorax-associated lymphoma– the first reported case in the UK

Abstract

An 84-year-old man presented with dyspnoea and chest pain, together with a chest X-ray demonstrating a complete white-out of the left hemithorax. Four decades earlier he had been treated for tuberculosis with an artificial pneumothorax. A diagnosis of pyothorax-associated lymphoma (exclusively B-cell non-Hodgkin’s type) was made. Strongly associated with Epstein-Barr virus infection, pyothorax-associated lymphoma is known to develop in the chronic inflammatory environment of a pleural cavity in patients with a long-standing history of pyothorax. Although the condition is responsive to chemo-radiotherapy, overall prognosis is poor (five-year survival of 21.6%). Our patient has demonstrated a remarkable response to surgical decortication and resection with adjuvant rituximab – cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) chemotherapy – and makes a case for routine debulking as part of the multimodality treatment of this unusual malignant complication of tuberculosis therapy.