Rapid onset debilitating illness with multiple vertebral lesions: A confounding diagnosis of peripheral T-cell lymphoma

Peripheral T-cell lymphomas (PTCL) are uncommon and aggressive. Various subtypes are described, and presentations vary accordingly. It tends to grow rapidly and eventually become widespread, involving extranodal sites. Most cases are diagnosed in late stages and hence carry a poor prognosis. We report a 68-year-old male with complaints of progressive low back pain that later became associated with rapid weight loss and fever, eventually leading to cauda equina syndrome. X-rays were nonspecific, but magnetic resonance imaging showed scattered multicentric osseous lesions involving all regions of spine, associated with epidural lesions corresponding to some of the affected levels. Considering the neurological status, posterior decompression surgery was done, and specimens of lesions were collected. Based on histopathology and detailed immunophenotyping, a diagnosis of PTCL, not otherwise specified was made, and appropriate chemotherapy was initiated. However, terminal stage disease was irremediable, and the patient eventually succumbed to the disease. Extensive multicentric spinal involvement of lymphoma on the first presentation is rare. It puts forth a considerable challenge for the diagnosis. Hence, early signs and symptoms should not be ignored. Histopathology and immunophenotyping are vital for the diagnosis. Making a definitive diagnosis at the earliest can prompt expeditious intervention to increase the survival rate.