Introduction
Angioimmunoblastic T-cell lymphoma (AITL) is a rare, systemic subtype of peripheral T-cell lymphoma characterized by profound immune dysregulation. Its ability to mimic infectious diseases, creates diagnostic challenges that delay treatment, particularly in tuberculosis endemic regions like the Philippines where granulomatous inflammation may obscure the diagnosis.
Objectives
To report a case of tonsillar AITL presenting as life-threatening airway obstruction, highlights its diagnostic pitfalls mimicking tuberculous lymphadenitis, and discuss the therapeutic response to brentuximab vedotin-CHP (BV-CHP) despite negligible CD30 expression.
Methods
We reviewed the patient's clinical course, radiologic findings, and sequential histopathologic evaluations. The diagnostic process involved an initial local biopsy followed by expert hematopathology review, which was critical in establishing the final diagnosis.
Results
A 64-year-old female presented with progressive neck swelling and tonsillar exudates. Fine-needle aspiration biopsy revealed chronic granulomatous lymphadenitis, leading to empiric anti-tuberculosis therapy. Despite treatment, her condition worsened, culminating in airway obstruction requiring tracheostomy. An incisional biopsy was initially interpreted as PTCL-NOS with CD3 and CD30 (5–15%) positivity. Expert review established the final diagnosis of AITL, Attygalle pattern 3, based on T-follicular helper markers (CD10, PD1, ICOS). CD30 expression was negligible on re-evaluation. Gomori Methenamine Silver staining revealed invasive fungal hyphae in necrotic tonsillar tissue, correlating with Candida growth. The patient received BV-CHP chemotherapy and achieved marked clinical and metabolic response after three cycles.
Conclusion
This case underscores that AITL is a clinical mimic that can present as a medical emergency. It highlights the indispensable role of expert pathology review in achieving diagnostic accuracy and demonstrates that the BV-CHP regimen may be effective in AITL even with negligible CD30 expression, contributing valuable real-world evidence.
