Fatal pulseless electrical activity in an African American man with natural killer/T-cell leukemia/lymphoma and myocardial involvement

Abstract

A 50-year-old previously healthy man presented with acute shortness of breath, fever, and back pain. Physical examination was normal. He rapidly developed hypoxemic respiratory failure requiring mechanical ventilation and pancytopenia. An extensive infectious work up was negative. After a gallium scan showed increased uptake in the lungs, he underwent bone marrow biopsy and open lung biopsy. The lung and bone marrow biopsies revealed Natural Killer/T-cell lymphoma/leukemia. Immediately after the open lung biopsy, the patient developed cardiac arrest with pulseless electrical activity from which he could not be resuscitated. At autopsy, he had extensive NK/T-cell lymphoma involving multiple organs, including the heart, lung, bone marrow, adrenal glands, and lymph nodes. The heart was the most prominently affected organ with involvement of the cardiac conduction system.