Relapsed Angioimmunoblastic T Cell Lymphoma with Fulminant Leukemic Involvement

Patient: Female, 45-year-old Final Diagnosis: Angioimmunoblastic T-cell lymphoma Symptoms: Fever • general malaise • weight loss Medication: — Clinical Procedure: Bone marrow biopsy • CT-scan • excision biopsy • PET-CT • splenectomy Specialty: Hematology • Oncology OBJECTIVE: Rare disease BACKGROUND: Angioimmunoblastic T cell lymphoma (AITL) is an aggressive and rare entity that comprises about 1–2% of all non-Hodgkin lymphomas. This entity carries many challenges that start at the diagnosis, as most patients present with non-specific symptoms affecting different systems. As a result, the optimal approach, reaching the accurate diagnosis, and delivering needed treatment are delayed. Furthermore, it is not surprising that the initial set of biopsies are non-diagnostic given the heavy inflammatory background and scarcity of malignant cells in the early course of the disease. Other challenges include delivering the optimal curative therapy, as there is no such therapeutic option available yet. Although stem cell transplantation (SCT) can be considered a curative option, some patients have comorbidities and are not eligible for this option, and some other patients have relapse despite this aggressive approach, as was seen in our case. CASE REPORT: We present an interesting case of AITL with florid leukemic infiltration at the time of relapse. We included a description of the patient’s symptoms, diagnostic challenges, and clinical course, and provided therapy with demonstrative peripheral blood and flow cytometry images. Interestingly, there are very few reports in the literature that described leukemic infiltration of this entity. CONCLUSIONS: Acknowledging the rarity of this aggressive lymphoma combined with all the challenges that face the involved health care workers, publishing this elaborative case report adds some insight and knowledge and helps improve our understanding of this entity.