Intravascular Large B-Cell Lymphoma: A Case Report

Intravascular large B-cell lymphoma (IVLBCL) is an uncommon variant of extranodal large B-cell lymphoma characterized by selective proliferation of lymphoma cells within the lumina of small to medium-sized vessels. There is no known etiologic factor but its growth pattern has been speculated to be due to a defect in homing receptor of tumor cells. This lymphoma can involve any organ, preferentially the central nervous system, lungs, and skin. However, the lymph nodes are usually spared. It affects the middle aged to elderly population, with a slight predominance in men. Intravascular large B-cell lymphoma is generally aggressive, and without treatment is rapidly fatal. Case presentation: This case describes a 69-year-old diabetic lady presented with fever of unknown origin (FUO) and pruritic skin lesions. On admission, hepatosplenomegaly was apparent, but without lymphadenopathy. The laboratory examination revealed bicytopenia and increased levels of liver enzymes. Histological analysis of the liver and bone marrow biopsy demonstrated proliferation of atypical lymphoid cells with positive immunoreactivity for CD20 in the small capillaries leading to the diagnosis of intravascular large B-cell lymphoma. However, her level of consciousness decreased and unfortunately she succumbed to the disease at initial phase of chemotherapy within the first week of her treatment. Conclusion:Intravascular large B-cell lymphoma is often a difficult diagnosis due to the exclusive intravascular growth pattern of the tumor cells and a fulminant clinical course. It is important to consider this diagnosis in the proper clinical settings as patients may achieve complete remission and long-term survival with an appropriate aggressive combination chemotherapy.

Keywords:

intravascular lymphoma , fever of unknown origin (FUO) , extranodal large B-cell lymphoma