DOI: 10.12890/2025_005389

Hairy cell leukaemia with an uncommon pulmonary presentation: a case report and review of the literature

Authors

  • Jen-Yu Chuang Division of Hematology and Oncology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
  • Meng-Ta Sung Division of Hematology and Oncology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Good Clinical Research Center, Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan
  • Kuan-Chih Kuo Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Division of Chest, Department of Internal Medicine, MacKay Memorial Hospital, Taiwan
  • Jie-Yang Jhuang Department of Pathology, MacKay Memorial Hospital, Taipei, Taiwan
  • Ken-Hong Lim Division of Hematology and Oncology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Good Clinical Research Center, Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan

prozacker@gmail.com

Keywords

Hairy cell leukaemia, bicytopenia, pulmonary lymphoma

Abstract

Introduction: Hairy cell leukaemia (HCL) is a rare B-cell neoplasm and pulmonary involvement in HCL is exceedingly rare, often leading to diagnostic challenges. Non-resolving pulmonary infiltrates have a broad differential, including infections, malignancies, and autoimmune diseases, requiring a multidisciplinary approach for diagnosis.
Case report: We report the case of a 61-year-old man who presented with fever, dyspnoea, weight loss, and bicytopenia. Initial chest imaging showed bilateral lower lung opacities, and empirical antibiotic therapy was administered. Despite treatment, symptoms persisted, prompting further investigations. High-resolution computed tomography scan revealed consolidations and ground-glass opacities. Extensive infectious workup was negative. Bronchoscopy with endobronchial ultrasound biopsy showed organizing pneumonia, and a bone marrow biopsy confirmed HCL with pulmonary involvement. The patient declined a surgical lung biopsy, but his pulmonary infiltrates and bicytopenia improved with corticosteroid and cladribine chemotherapy.
Conclusion: This case highlights the importance of considering haematologic malignancies in non-resolving pulmonary infiltrates and persistent bicytopenia. A stepwise diagnostic approach, including bone marrow biopsy and bronchoscopy, was crucial in establishing the diagnosis. Successful treatment with cladribine reinforces its efficacy in HCL and suggests similar cases may benefit from this approach. Further research is needed to optimize diagnostic and treatment strategies for HCL with pulmonary involvement.

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References

  1. Troussard X, Maitre E, Paillassa J. Hairy cell leukemia 2024: Update on diagnosis, risk-stratification, and treatment-Annual updates in hematological malignancies. Am J Hematol 2024;99:679-696. doi: 10.1002/ajh.27240
  2. Falini B, Tiacci E. Hairy-Cell Leukemia. N Engl J Med 2024;391:1328-1341. doi: 10.1056/NEJMra2406376
  3. Robak T, Braun M, Janus A, Guminska A, Robak E. Rare Clinical Symptoms in Hairy Cell Leukemia: An Overview. Cancers (Basel) 2024;16:3054. doi: 10.3390/cancers16173054
  4. Angirish B, Sanghavi P, Jankharia B. Pulmonary manifestations of lymphoma: A pictorial essay. Lung India 2020;37:263-267. doi: 10.4103/lungindia.lungindia_200_19
  5. Ecsiova D, Kamaradova K, Nova M, Hoffmann P, Rozsivalova P, Simkovic M, et al. Pulmonary damage in a patient with hairy cell leukemia - infectious involvement or hematological disease activity? Case report. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023;167:385-389. doi: 10.5507/bp.2022.026
  6. Hansen T, Constantin C, Weber M, Titze U, Hartmann F. Bronchoalveolar lavage in hairy cell leukemia with pulmonary infiltration. Pathologe 2019;40:529-533. doi: 10.1007/s00292-019-0586-3
  7. Fields BN, Harris NL. A 50-Year-Old Man with Hairy Cell Leukemia, Recurrent Fever, and Variable Pulmonary Infiltrates. N Engl J Med 1982;307:1693-1700. doi: 10.1056/NEJM198212303072707
  8. Gnanaraj J, Parnes A, Francis CW, Go RS, Takemoto CM, Hashmi SK. Approach to pancytopenia: Diagnostic algorithm for clinical hematologists. Blood Rev 2018;32:361-367. doi: 10.1016/j.blre.2018.03.001
  9. Athanasia Pataka M. Assessment of persistent pulmonary infiltrate. BMJ best practice 2024
  10. Menéndez R, Torres A, Zalacaín R, Aspa J, Martín Villasclaras JJ, Borderías L, et al. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax 2004;59:960-965. doi: 10.1136/thx.2003.017756
  11. Korevaar DA, Colella S, Fally M, Camuset J, Colby TV, Hagmeyer L, et al. European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases. Eur Respir J 2022;60:2200425. doi: 10.1183/13993003.00425-2022

Published

2025-06-03

Issue

Vol. 12 No. 7 (2025)

Categories

How to Cite

1.
Chuang J-Y, Sung M-T, Kuo K-C, Jhuang J-Y, Lim K-H. Hairy cell leukaemia with an uncommon pulmonary presentation: a case report and review of the literature. EJCRIM [Internet]. 2025 Jun. 3 [cited 2026 Nov. 4];12(7). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5389