Clinical and Medical Case Reports

Biography

Biography: Rittigorn Apinhapanit

Abstract

A 20 year-old male presented with two months history of progressive dyspnea with night sweat and dry cough. He was admitted at Lerdsin hospital due to fever for 2 weeks and increase productive sputum. Initial investigation showed mild leukocytosis, chest radiograph showed right lower lobe consolidation and sputum AFB was negative for 3 days. He was clinically diagnosed community acquired pneumonia. After 10 days of intravenous ceftriaxone and oral azithromycin. His fever and sputum were improved but he still had dyspnea especially on lying position. Physical examination revealed central rhonchi after force inspiration suspected of endobronchial lesion. Computer tomography of chest was performed and revealed large endotracheal mass extend to right main bronchus and bronchus intermedius causing obstructive pneumonia at right middle lobe. Flexible bronchoscopy with cryotherapy and endobronchial mass removal was performed, showed intraluminal lobulated endobronchial mass at right anterior portion of the trachea extend to proximal right main bronchus. The pathology revealed positive hematologic malignancy along with positive CD3 (diffuse presence of T-cell) and CD 20 (patchy density). Hodgkin’s lymphoma was diagnosed and then his was sent to hematologist for aggressive chemotherapy. This case is the rare presentation of Hodgkin’s lymphoma because almost cases of lymphoma-related endobronchial mass usually presented in non-Hodgkin’s disease. The hallmark of diagnosis of large endobronchial lesion are presented of dyspnea on lying position (mass effect) and physical examination shown central rhonchi after force inspiration which are helpful for general physician to prevent missing some early-curable disease like this case.