Diagnostic utility of mediastinal cryobiopsy through endobronchial ultrasound in a young female with suspected lymphoproliferative disorder

Lymphomas are characterized by their varied clinical presentations. However, initial presentation with pleuropericardial effusion in a young, otherwise healthy female is uncommon and can mimic infectious or inflammatory conditions, particularly tuberculosis in endemic regions. A 27-year-old female presented with a 2-week history of cough and breathlessness. Imaging revealed bilateral pleural effusion (left > right) and moderate pericardial effusion. Pleural fluid analysis demonstrated an exudative effusion with elevated adenosine deaminase levels (79 U/L) and the presence of atypical cells. Positron emission tomography-computed tomography showed a metabolically active anterior mediastinal mass with systemic lymphadenopathy. Endobronchial ultrasound-guided mediastinal cryobiopsy confirmed the diagnosis of large cell lymphoma. This case underscores the importance of considering malignancy in patients with atypical presentations, even among young adults. It also highlights the critical role of multimodal diagnostic approaches in distinguishing between tuberculosis and lymphoma in regions where tuberculosis is endemic.