Recommended Citation
Lakkamsani A, Patel R, Syed S, Bikeyeva V, Bufalino S. Clinically Confounded: Pericardial Effusion as the Initial Presentation of Diffuse Large B-Cell Lymphoma in a Patient with Cirrhosis. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
Pericardial effusion as the initial manifestation of diffuse large B-cell lymphoma (DLBCL) is a rare, extranodal presentation that upstages the disease to stage IV, per Lugano classification. In patients with underlying cirrhosis or volume overload, such effusions can be misattributed, delaying oncologic evaluation. We present a case of new pericardial effusion found to be DLBCL in the setting of alcoholic cirrhosis.
Description:
A 79-year-old male with alcoholic cirrhosis presented with bilateral lower extremity edema, abdominal edema, and hypotension that was unresponsive to outpatient diuresis. On admission, day 0, imaging showed cardiomegaly concerning pericardial effusion and left pleural effusion. Echocardiography revealed a fibrinous circumferential pericardial effusion and preserved ejection fraction (65%). Pericardiocentesis removed 650mL of serosanguinous fluid. Fluid studies showed elevated LDH and protein. Further cytology and flow cytometry confirmed DLBCL, activated B-cell subtype (CD10-, CD5-). The patient continued to have accumulation of effusion on repeat echocardiograms, despite consistent drainage. The patient was evaluated by oncology and cardiothoracic surgery, with chemotherapy chosen over surgical intervention. Rituximab with dose-reduced cyclophosphamide, doxorubicin, vincristine, and prednisone (R-miniCHOP) was initiated on day 8 with filgrastim support. Following initiation of chemotherapy, the patient struggled with pancytopenia, renal injury, and hepatic encephalopathy. The patient’s continued decline in the setting of his severe illness led to election of hospice and passing away on hospital day 21.
Discussion:
This case demonstrates DLBCL presenting as an isolated pericardial effusion in a patient with overlapping cirrhosis, confounding the cause of his hypervolemia. Diagnosis was achieved through pericardial fluid cytology, enabling early initiation of chemotherapy- though underlying comorbidities limited tolerance and aggression of treatment. This is noted by the usage of R-miniCHOP as opposed to the standard R-CHOP. This case expands the literature regarding extranodal, pericardial DLBCL and elucidates the importance of oncologic vigilance in complex presentations to ensure early intervention. In individuals like above, pericardial fluid should undergo cytologic and cytometric analysis to exclude malignancy as well as early multidisciplinary involvement for prompt intervention.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Clinically Confounded: Pericardial Effusion as the Initial Presentation of Diffuse Large B-Cell Lymphoma in a Patient with Cirrhosis
Introduction/Background:
Pericardial effusion as the initial manifestation of diffuse large B-cell lymphoma (DLBCL) is a rare, extranodal presentation that upstages the disease to stage IV, per Lugano classification. In patients with underlying cirrhosis or volume overload, such effusions can be misattributed, delaying oncologic evaluation. We present a case of new pericardial effusion found to be DLBCL in the setting of alcoholic cirrhosis.
Description:
A 79-year-old male with alcoholic cirrhosis presented with bilateral lower extremity edema, abdominal edema, and hypotension that was unresponsive to outpatient diuresis. On admission, day 0, imaging showed cardiomegaly concerning pericardial effusion and left pleural effusion. Echocardiography revealed a fibrinous circumferential pericardial effusion and preserved ejection fraction (65%). Pericardiocentesis removed 650mL of serosanguinous fluid. Fluid studies showed elevated LDH and protein. Further cytology and flow cytometry confirmed DLBCL, activated B-cell subtype (CD10-, CD5-). The patient continued to have accumulation of effusion on repeat echocardiograms, despite consistent drainage. The patient was evaluated by oncology and cardiothoracic surgery, with chemotherapy chosen over surgical intervention. Rituximab with dose-reduced cyclophosphamide, doxorubicin, vincristine, and prednisone (R-miniCHOP) was initiated on day 8 with filgrastim support. Following initiation of chemotherapy, the patient struggled with pancytopenia, renal injury, and hepatic encephalopathy. The patient’s continued decline in the setting of his severe illness led to election of hospice and passing away on hospital day 21.
Discussion:
This case demonstrates DLBCL presenting as an isolated pericardial effusion in a patient with overlapping cirrhosis, confounding the cause of his hypervolemia. Diagnosis was achieved through pericardial fluid cytology, enabling early initiation of chemotherapy- though underlying comorbidities limited tolerance and aggression of treatment. This is noted by the usage of R-miniCHOP as opposed to the standard R-CHOP. This case expands the literature regarding extranodal, pericardial DLBCL and elucidates the importance of oncologic vigilance in complex presentations to ensure early intervention. In individuals like above, pericardial fluid should undergo cytologic and cytometric analysis to exclude malignancy as well as early multidisciplinary involvement for prompt intervention.
Affiliations
Advocate Lutheran General Hospital