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Acute T-cell lymphoblastic lymphoma is a rare subtype of non-Hodgkin’s lymphomaaccounting for 2% of adult non-Hodgkin’s lymphomas. Cardiac involvement in non-Hodgkin’slymphoma is usually a late manifestation, and pericardial effusion as an initial presentationis rare. We report a case of acute T-cell lymphoblastic lymphoma in a patient who initiallypresented with pericardial effusion. Diagnosis was difficult and challenging, as an infectiousetiology was first suspected. The patient presented with pericardial effusion without othercommon clinical manifestations of lymphoma, such as fever, night sweats, and weight loss. Hewas treated for constrictive pericarditis due to having positive Coxsackie B serology but hadno improvement with treatment. The pathology results of the pericardium after pericardiectomyreported fibrosis with a reactive lymphohistiocyte infiltrate. After CT scan revealed a largemediastinal mass, a lymph node biopsy was performed, and T-cell lymphoblastic lymphomawas confirmed. A detailed evaluation to search for occult malignancy should be considered inpatients who have persistent pericarditis that is unresponsive to anti-inflammatory therapy andin those who present with a new, large pericardial effusion or cardiac tamponade.

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Hyperthyroidism is a common endocrine disorder with a prevalence of 1.3% in the generalpopulation, affecting more women than men. Prolonged hyperthyroidism without appropriatemanagement may lead to high output cardiac failure characterized by increases in heart rate,cardiac contractility, and cardiac output and by reductions in peripheral systemic vascularresistance. Dilated cardiomyopathy with impaired systolic function is rare and occurs in lessthan 1% of patients with thyrotoxicosis. The exact mechanism of hyperthyroidism-induceddilated cardiomyopathy is not well established. The combination of direct toxic effects of excessthyroid hormone along with prolonged tachycardia, arrhythmia, and a hyperdynamic state couldbe contributing factors. We present a case of a young woman with prolonged sinus tachycardiadue to a long history of medication non-compliance who developed dilated cardiomyopathywith low output heart failure. Early detection and management of hyperthyroidism are crucialto restore cardiac function.

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