Diffuse large B cell lymphoma presenting as multiple cavitary lung lesions

A female patient in her 50s presented to the hospital with a 2 months history of shortness of breath and productive cough. She also had ongoing fatigue and unintentional weight loss. Investigations demonstrated a normal white cell count and elevated lactate dehydrogenase). A CT scan of the chest revealed multiple bilateral cavitary lung masses and pulmonary nodules. Bronchoscopy with transbronchial biopsy and fine needle aspiration of mediastinal lymph node was performed. The histopathology was consistent with the non-germinal centre B cell subtype of diffuse large B cell lymphoma (DLBCL). A regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone was started, which improved her symptoms. Although a rare presentation, this case highlights the need to consider DLBCL among the differential diagnoses for cavitary lung lesions when the workup fails to elicit an alternate cause. Given its aggressive nature, prompt diagnosis and treatment are critical.