Diffuse Large B-Cell Lymphoma of the Thyroid Presenting with Biphasic Stridor and Respiratory Failure: Case Report

Case RepoRt Day 3: CECT neck revealed thyroid mass compressing trachea.The USG neck showed high vascularity; thyroidectomy with tracheostomy had to be deferred in view of possible on-table mortality.USG-guided biopsy suggested anaplastic thyroid carcinoma or lymphoma (Fig. 4). Days 4 to 6: Received micafungin, intravenous antibiotics, serial bronchoscopy, and supportive therapy. IntroductIonPrimary thyroid lymphomas are rare, accounting for less than 5% of thyroid malignancies and about 2% of extranodal lymphomas. 1Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype. 2 Patients typically present with a rapidly enlarging neck mass and compressive symptoms, but acute airway obstruction requiring mechanical ventilation is uncommon. 3This case is notable for its dramatic presentation with life-threatening airway compromise, diagnostic complexity, and rapid clinical stabilization following targeted therapy. case descrIptIonA woman in her early 60s, a homemaker with hypothyroidism, no history of Hashimoto's thyroiditis, and previously treated pulmonary tuberculosis, presented to the chest emergency department with acute respiratory distress, hemoptysis, progressive dyspnea, biphasic stridor, and cough with expectoration.Her SpO was 81% on room air despite highflow oxygen (10 L/min).She deteriorated rapidly, requiring endotracheal intubation and invasive mechanical ventilation.No B symptoms were present, and thyroid peroxidase (TPO) antibodies were negative.The patient was planned to undergo excision of thyroid mass and tracheostomy, but extreme vascularity and high oxygen requirement in ventilator prevented surgical intervention.DLBCL diagnosis led to a nonsurgical rituximab-based regime and the patient was subsequently extubated. table o f event tImelIne Day 1: Presented with biphasic stridor and hypoxemia, underwent CXR (Fig. 1) showing neck swelling; intubated, bronchoscopy done (Fig. 2); HRCT chest and CECT neck (Fig. 3) performed.