Münevver Nur Duran, Daniel Ocazionez-Trujillo
Archives of Basic and Clinical Research - 2025;7(3):200-203
Malignant pericardial involvement is a rare manifestation of non-Hodgkin's lymphoma (NHL), particularly in immunocompromised individuals. In human immunodeficiency virus (HIV)-positive patients, this condition is especially uncommon and presents diagnostic challenges. Radiologic imaging is essential for early detection and management. An 80-year-old HIV-positive man with chronic kidney disease and a history of NHL presented with progressive dyspnea and a productive cough. Imaging revealed a large pericardial effusion with tamponade physiology. Urgent echocardiography-guided pericardiocentesis drained serosanguineous fluid. Chest computed tomography (CT) demonstrated diffuse nodular pericardial thickening and mediastinal lymphadenopathy, raising suspicion for malignant pericardial disease. Cytologic analysis confirmed diffuse large B-cell lymphoma. A pericardial catheter was placed for recurrent effusion management. Although initially stabilized, the patient developed tumor lysis syndrome and septic shock, and care was transitioned to hospice. Malignant pericardial effusion as an initial presentation of NHL in HIV-positive patients is rare. Differential diagnoses include opportunistic infections, Kaposi's sarcoma, and primary pericardial malignancies. Multimodal imaging, especially echocardiography and CT, plays a crucial role in diagnosing, guiding emergent interventions, and informing treatment planning. This case highlights the importance of integrating imaging with clinical findings to manage complex presentations in immunocompromised populations.
