Pleomorphic T- cell Immunoblastic Non-Hogdkin’s Lymphoma with Peripheral Eosinophilia: A Case Report

Hypereosinophilia is defined as peripheral blood eosinophil count > 1500/ l and is often seen associated with many hematolymphoid malignancies. The present case describes a 75 year old male who presented initially with eosinophilia and complaints related to allergic bronchitis and atopy. After a period of irregular follow – up (two years after his initial diagnosis) patient came in emergency with severe dyspnoea and cough. Chest X-Ray showed multiple hilar opacities with CT chest revealing mediastinal lymph nodes including cervical and supra-clavicular lymphadenopathy. Hematological findings were leucocytosis with hypereosinophilia. (Total leukocyte count-65,000/cumm, comprising of 80% eosinophils, 09% neutrophils and 11% lymphocytes). Fine needle aspiration done from various sites was suggestive of lymphoproliferative disorder. On histopathology; working diagnosis of NHL- Large cell type was rendered with IHC showing immunopositive for LCA(CD45)/CD3 /CD45RO, and immunonegative for CD7/ CD20. The Ki-67 index was 90%. Hence a final diagonosis of Pleomorphic T –cell Lymphoma High grade (Large Cell, Immunoblastic Lympoma of T-cell Type of WHO/REAL Working Formulation) was rendered. HES has two pathogenic forms – myeloproliferative and lymphocytic. Lymphocytic – HES which is associated with increased risk of developing a T-Cell lymphoma later on due to secretion of IL-5 by abnormal clonal T- cells. It is recommended in all the cases of long standing eosinophilia and HES patient to be kept under follow up for early detection of development of T-cell lymphoma.