{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T18:53:34Z","timestamp":1768244014396,"version":"3.49.0"},"reference-count":13,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,1]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>A married woman in her early 30s presented with 2\u2009months of dry cough, progressive dyspnoea and weight loss. Imaging revealed massive right pleural and severe pericardial effusions with a large anterior mediastinal mass. Initial lymphocyte-predominant exudative effusion suggested tuberculous pleuritis, but cytology was inconclusive. Thoracoscopic pleural biopsy with immunohistochemistry showed TdT-positive and CD7-positive lymphoid cells, establishing a diagnosis of T-lymphoblastic lymphoma (T-LBL) involving the pleura, pericardium and mediastinum. She received acute lymphoblastic leukaemia\u2013type multi-agent chemotherapy and remains well, with no recurrence of effusion on follow-up. This case highlights the diagnostic challenge of distinguishing rare lymphomas from common infections in tuberculosis-endemic regions and underscores the necessity of early tissue diagnosis with immunophenotyping when faced with unexplained large pleuro-pericardial effusions. Prompt recognition is crucial because T-LBL requires intensive ALL-type therapy, which significantly improves survival compared with conventional lymphoma regimens.<\/jats:p>","DOI":"10.1136\/bcr-2025-269960","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T15:31:07Z","timestamp":1768231867000},"page":"e269960","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["T-lymphoblastic lymphoma presenting as massive pleuro-pericardial effusions: a rare diagnostic challenge in TB endemic regions"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1683-9348","authenticated-orcid":false,"given":"Supriya","family":"Adiody","sequence":"first","affiliation":[{"name":"Respiratory Medicine, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7468-4626","authenticated-orcid":false,"given":"Vishnu","family":"Narayanan","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akhil","family":"Paul","sequence":"additional","affiliation":[{"name":"Pulmonary and Sleep Medicine, MOSC Medical Mission Hospital, Thrissur, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoj","family":"Ravi","sequence":"additional","affiliation":[{"name":"Cardiology, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepthy","family":"Vijayaraghavan","sequence":"additional","affiliation":[{"name":"Pathology, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohini","family":"Sebastian","sequence":"additional","affiliation":[{"name":"Pathology, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"2026011207302635000_19.1.e269960.1","unstructured":"Swerdlow SH , Campo E , Harris NL , eds. 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