A Case of Malignant Lymphoma that was Difficult to Diagnose Based on Symptoms Similar to Acute Epiglottitis

Abstract

Malignant lymphoma rarely occurs in the larynx and sometimes presents with symptoms similar to those of acute epiglottitis. We experienced a case of malignant lymphoma that was difficult to diagnose based on atypical local findings. The patient was a 66-year-old male who had complained of a sore throat for one week and consulted a nearby otolaryngologist. He was diagnosed with acute epiglottitis and referred to our hospital. Upon presentation, his epiglottis was reddish and swollen, similar to the findings of acute epiglottitis, although there were no laboratory data indicative of acute inflammation. The patien’s symptoms and local findings were subsequently improved by treatment with antibiotics and an intravenous steroid drip for three days. However, seven months later，the same symptoms recurred and a white mass appeared on the surface of the oropharynx (anterior palatine arch and root of the tongue)with cervical lymph node swelling. No inflammatory reactions were observed on laboratory studies, and the finding of CT, MRI and PET examinations did not suggest any malignant tumors. Therefore, biopsies of the larynx, oropharynx and cervical lymph nodes were performed several times, and the patient was ultimately diagnosed with peripheral T-cell lymphoma.
He was subsequently treated with chemoradiotherapy and completely recovered. However, the disease recurred in the intestines two years later, and he died of aspiration pneumonia and ileus.
Although malignant lymphoma that occurs in the larynx is rare, it is necessary to consider this disease in the differential diagnosis in patients with symptoms similar to acute epiglottitis.