BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is an aggressive tumor derived from mature B cells and is the most common type of non-Hodgkin’s lymphoma (NHL). Cardiac invasion is rare and heart rupture or cardiac arrest can cause increased risk. Patients with DLBCL progress rapidly and are prone to recurrence, although its 5-year survival rate is high. The clinical manifestations of these patients lack specificity and this can delay diagnosis. Herein, we present a rare case of DLBCL with cardiac and multiorgan metastases and discuss the diagnostic and therapeutic challenges.

CASE REPORT: A 63-year-old woman was admitted to the hospital due to abdominal distension and abdominal pain. A chest computed tomography (CT) scan indicated no abnormal changes in her heart. She was diagnosed with DLBCL with cardiac metastasis and multiple systemic metastases by contrast-enhanced CT and pathology biopsy. She was started on the standard R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). However, she developed severe bradycardia, necessitating regimen modification to R-CEOD (rituximab, cyclophosphamide, pirarubicin, etoposide). Following 3 cycles of treatment with R-CEOD, the overall efficacy was assessed as partial response (PR).

CONCLUSIONS: For patients with DLBCL combined with cardiac metastasis, treatment regimens containing anthracyclines are preferred whenever possible. Cardiac function was assessed by echocardiography and electrocardiogram and by assessing the levels of brain natriuretic peptide prior to treatment. During the process of treatment, the toxic effects of chemotherapeutic drugs, notably cardiac adverse reactions, were closely monitored and quickly treated.

Keywords: Chemotherapy, Adjuvant, Heart Neoplasms, Lymphoma, Large B-Cell, Diffuse, Arrhythmias, Cardiac