SHM Converge Scientific Abstract ePoster Gallery-Refractory Hypotension Due to Diffuse Large B-Cell Lymphoma

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This case describes a 63-year-old man who initially presented with progressive dyspnea, bilateral pleural effusions, lower-extremity weakness, numbness, and low back pain. Early imaging was inconclusive: chest CT showed no masses or clear malignancy, while MRI suggested possible metastatic disease. Because pleural fluid cytology was negative and the symptoms were nonspecific, his complaints were initially attributed to other conditions such as diabetic neuropathy, heart failure, or cirrhosis.<br /><br />He was later readmitted two weeks after discharge with worsening pleural effusions and severe refractory hypotension in the 80s/60s. Despite aggressive fluid resuscitation and midodrine, his blood pressure remained low. Further evaluation revealed a pericardial effusion, and right heart catheterization with pericardiocentesis showed high-normal cardiac output with low systemic vascular resistance. Extensive workup for common causes of hypotension, including infection, endocrine disease, liver disease, protein-losing states, and heart failure, was negative.<br /><br />The diagnosis was ultimately made when flow cytometry of pericardial fluid showed diffuse large B-cell lymphoma (DLBCL), later confirmed by bone marrow biopsy. He was started on R-CHOP chemotherapy, after which his hypotension, effusions, and neuropathy resolved.<br /><br />The report highlights that DLBCL can present in unusual ways, including refractory hypotension, recurrent pleural and pericardial effusions, and neuropathy, even without obvious lymphadenopathy or a mass lesion on CT. It also emphasizes that negative cytology does not exclude lymphoma, since malignant cells may appear normal on morphology but be clonal on flow cytometry. Physicians should consider lymphoma in patients with unexplained hypotension and recurrent effusions, especially when imaging and routine studies are unrevealing.

Asset Subtitle

Tarek Alsibai

Meta Tag

Author List Jeremy J. Gentile, Tarek Alsibai

Category Clinical Vignettes

Concept Diffuse Large B-Cell Lymphoma

Concept Hypotension

Concept Flow Cytometry

Concept Peripheral Neuropathy

Concept Pleural Effusion

Distinguished Non-Finalist

Presenter Organization Corewellhealth/Msu

Presenting Author Tarek Alsibai

Track Adult

Keywords

diffuse large B-cell lymphoma

refractory hypotension

pleural effusion

pericardial effusion

flow cytometry

bone marrow biopsy

neuropathy

R-CHOP chemotherapy

low systemic vascular resistance

unexplained hypotension

Diffuse Large B-Cell Lymphoma

Hypotension

Flow Cytometry

Peripheral Neuropathy

Pleural Effusion