Sousa Sandra R, Pereira Cátia M L, Ferraz Patrícia, Blanco Miriam
Internal Medicine Department, Unidade Local de Saúde do Nordeste, Bragança, PRT.
Hematology Department, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, PRT.
Cureus. 2024 Dec 3;16(12):e75040. doi: 10.7759/cureus.75040. eCollection 2024 Dec.
The authors describe a rare case of non-Hodgkin lymphoma (NHL) with primary involvement of the external auditory canal (EAC) and subsequent dissemination to the central nervous system, initially manifesting as a benign ear infection. This case highlights the importance of considering differential diagnoses in patients with persistent or worsening symptoms unresponsive to empirical treatment. A 53-year-old man presented with a one-week history of aural fullness, otalgia, and otorrhea in the left ear. The first examination of the EAC showed no masses or lesions, but the tympanic membrane was bulging and erythematous. A diagnosis of acute otitis media was established, and the patient started empirical antibiotic treatment. However, the patient's symptoms worsened during the course of therapy. A brain MRI revealed a lesion occupying the left EAC, extending to the retro-auricular region, surrounding the mastoid. The patient underwent an excisional biopsy of a postauricular lesion, and histological examination was compatible with diffuse large B-cell lymphoma. Chemotherapy was initiated, but at the end of the treatment, the disease progressed. The patient subsequently underwent second-line chemotherapy and was referred for a transplant consultation. In this case, the NHL of the EAC initially presented as an apparently benign ear infection, masking the underlying severity of the disease. In summary, NHL presents a significant challenge, not only because of their heterogeneous and non-specific clinical presentation which can delay diagnosis but also because of the difficulty in treatment. This report emphasizes the need for high clinical suspicion and a comprehensive diagnostic approach to improve the prognosis of patients with NHL in atypical locations.
作者描述了一例罕见的非霍奇金淋巴瘤（NHL），其原发于外耳道（EAC），随后扩散至中枢神经系统，最初表现为良性耳部感染。该病例凸显了对经验性治疗无反应的持续性或恶化症状患者进行鉴别诊断的重要性。一名53岁男性，有左耳耳闷、耳痛和耳漏一周的病史。首次对外耳道检查未发现肿物或病变，但鼓膜膨出且充血。诊断为急性中耳炎，患者开始接受经验性抗生素治疗。然而，患者症状在治疗过程中恶化。脑部MRI显示一个病变占据左侧外耳道，延伸至耳后区域，包绕乳突。患者接受了耳后病变切除活检，组织学检查结果符合弥漫性大B细胞淋巴瘤。开始化疗，但治疗结束时疾病进展。患者随后接受二线化疗，并被转诊进行移植咨询。在该病例中，外耳道NHL最初表现为看似良性的耳部感染，掩盖了疾病潜在的严重性。总之，NHL是一个重大挑战，不仅因其临床表现异质性和非特异性可导致诊断延迟，还因其治疗困难。本报告强调需要高度的临床怀疑和全面的诊断方法，以改善非典型部位NHL患者的预后。
