Extranodal Natural Killer/T-cell Lymphoma, Nasal Type Presenting with Myocardial Involvement and Severe Heart Failure

We report a rare case of exteranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKL) with myocardial involvement and severe heart failure. A 50-year-old Japanese woman who presented with nasal obstruction feel and palpitation on exertion was introduced to our hospital. Computed tomography (CT) imaging showed a mass in the right nasopharynx. Echocardiography confirmed left ventricular hypertrophy and a moderate pericardial effusion without tamponade physiology. As the patient’s left ventricular ejection fraction was depressed at 30%, heart failure was therefore diagnosed. Biopsy of the right nasopharyngeal mass revealed pathologic features diagnostic ENKL. Endomyocardial biopsy from the left ventricular posterior wall demonstrated myocardial involvement of ENKL.The patient received 3 cycle of systemic chemotherapy including of steroids, methotrexate, ifosfamide, L-aspaginase, and etoposide (SMILE). Myocardial function was improved with treatment of SMILE, but she died from progressive lymphoma within 2 months of completing 3 cycle of chemotherapy. Although, prognosis remains poor in disseminated ENKLs, the clinical course of the patient suggests that SMILE regimen is worth trying for ENKL patients with myocardial involvement.