Saad Bin Zafar Mahmood
Aga Khan University Hospital, Pakistan
Title: An unusual case of non-resolving cellulits with underlying deep venous thrombosis
Biography
Biography: Saad Bin Zafar Mahmood
Abstract
A 50 year-old lady presented to emergency room with worsening right upper arm swelling, pain and intermittant fever for one month, examination and workup revealing cellulitis along with deep venous thrombosis (DVT) of right brachial vein, hence started on enoxaparin and antibotics. With no resolution of symptoms even after escalation of antibiotics magnetic resonance imaging of right shoulder and arm was done showing swelling and subcutaneous inflammatory changes in deltoid, biceps and triceps and an abnormal signal area with negative contrast enhancement in deltoid prompting a trucut biopsy along with Positron emission tomography scan which showed massive hypermetabolic soft tissue lesion involving the right shoulder, scapula and proximal two third of arm with additonal deposits in spleen, left kidney, pancreas and marrow deposits in axial and appendicular skeleton. Histopathology confirmed diagnosis of Primary skeletal muscle Diffuse large B-cell lymphoma (DLBCL) and aggressive treatment was initiated wih R-EPOCH regimen however she expired within a week of the first cycle of chemotherapy. Primary skeletal muscle lymphomas are exceptionally rare accounting for only 0.5% of extranodal lymphomas which themselves constitute only around 20-30% of all Non-Hodgkin lymphomas. The most commonly involved sites are lower extremities, pelvis and gluteal muscles, with only seven reported cases in the upper extremity and only one with an initial finding of DVT. This case shows that although primary skeletal muscle lymphomas are rare, they should be kept in consideration where symptoms are non-resolving as delay can result in poor outcomes.