表现为乳糜胸和谵妄的成熟 NK 细胞淋巴瘤：一例罕见急症病例

Extranodal natural killer (NK)/T-cell lymphomas constitute less than 1% of non-Hodgkin lymphomas, with central nervous system involvement and chylothorax representing exceptionally rare presentations. This unique combination has not been previously reported in emergency medicine literature. CASE PRESENTATION: A previously healthy 51-year-old Chinese male presented with progressive dyspnea, high fever, and bilateral pleural effusion over eight days. Physical examination revealed extensive ecchymoses, bilateral lung consolidation, and splenomegaly. Laboratory studies demonstrated pancytopenia (WBC 3.26 10 /L, platelets 58 10 /L), severe coagulopathy, and elevated lactate dehydrogenase (773 U/L). Thoracentesis confirmed chylothorax with triglyceride levels of 1.46 mmol/L and positive Sudan III staining. On hospital day 10, the patient developed acute hyperactive delirium with visual hallucinations and paranoid behavior. Flow cytometry revealed abnormal NK-cell expansion across peripheral blood (68.09%), bone marrow (13.75%), and pleural fluid (87.34%), establishing the diagnosis of mature NK-cell lymphoma with multi-site involvement. PET-CT imaging demonstrated splenic involvement (SUVmax 9.0) and a hypodense lesion in the left occipital lobe. Despite supportive care including oxygen therapy, empirical antibiotics, and sedation, the patient rapidly progressed to hemophagocytic lymphohistiocytosis and multi-organ failure, resulting in death within four weeks of presentation.

This case demonstrates that mature NK-cell lymphoma may present with the previously unreported combination of chylothorax and acute delirium in emergency settings. Emergency physicians should maintain heightened awareness of hematologic malignancies when encountering patients with unexplained pleural effusion, neuropsychiatric symptoms, and cytopenias, as early recognition and prompt hematology consultation may influence clinical outcomes despite the typically aggressive disease course.