Pyothorax-associated lymphoma – the first reported case in the UK

An 84-year-old man presented with dyspnoea and chest pain, together with  a  chest  X-ray  demonstrating  a  complete  white-out  of  the  left  hemithorax. Four  decades  earlier  he  had  been  treated  for  tuberculosis  with  an  artificial pneumothorax. A  diagnosis  of  pyothorax-associated  lymphoma  (exclusively  B-cell non-Hodgkin’s  type)  was  made.  Strongly  associated  with  Epstein-Barr  virus infection,  pyothorax-associated  lymphoma  is  known  to  develop  in  the  chronic inflammatory  environment  of  a  pleural  cavity  in  patients  with  a  long-standing history of pyothorax. Although the condition is responsive to chemo-radiotherapy, overall prognosis is poor (five-year survival of 21.6%). Our patient has demonstrated a  remarkable  response  to  surgical  decortication  and  resection  with  adjuvant rituximab  – cyclophosphamide,  doxorubicin,  vincristine,  prednisolone  (R-CHOP) chemotherapy – and makes a case for routine debulking as part of the multimodality treatment of this unusual malignant complication of tuberculosis therapy.