D’Angelo CR, Ku K, Gulliver J, Chang J. Intravascular large B-cell lymphoma presenting with altered mental status: A case report. World J Clin Oncol 2019; 10(12): 402-408 [PMID: 31890649 DOI: 10.5306/wjco.v10.i12.402]
Corresponding Author of This Article
Julie Chang, MD, Assistant Professor, Department of Medicine, Section of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53792, United States. jc2@medicine.wisc.edu
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Dec 24, 2019; 10(12): 402-408 Published online Dec 24, 2019. doi: 10.5306/wjco.v10.i12.402
Intravascular large B-cell lymphoma presenting with altered mental status: A case report
Christopher Robert D’Angelo, Kimberly Ku, Jessica Gulliver, Julie Chang
Christopher Robert D’Angelo, Kimberly Ku, Julie Chang, Department of Medicine, Section of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
Jessica Gulliver, Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
Author contributions: D’Angelo CR wrote the manuscript and prepared the figures; Ku K and Chang J were involved in direct patient care for this case report and reviewed/revised the manuscript; Gulliver J performed the pathology review and contributed the pathology images; all authors assisted in preparation and final review of the manuscript.
Informed consent statement: The subject involved in this case report died from complications of his disease and therefore was unable to provide informed consent. A letter was mailed to his next-of-kin describing our intent to submit his case as an anonymous case report, and contact information was provided should the next-of-kin have concerns with publication. We received no such notice.
Conflict-of-interest statement: The authors have no conflicts-of-interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Julie Chang, MD, Assistant Professor, Department of Medicine, Section of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53792, United States. jc2@medicine.wisc.edu
Telephone: +1-608-2623970 Fax: +1-608-2624598
Received: March 6, 2019 Peer-review started: March 8, 2019 First decision: April 18, 2019 Revised: August 21, 2019 Accepted: November 17, 2019 Article in press: November 17, 2019 Published online: December 24, 2019 Processing time: 289 Days and 10 Hours
Abstract
BACKGROUND
Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings. Early diagnosis is critical to altering the disease course as early treatment with chemoimmunotherapy is required to prevent a rapidly fatal outcome. Strategies including improved awareness of this clinical entity through publication of cases with unique presentations are essential to prompt consideration of IVLBCL early in the disease workup. Here, we present a case of IVLBCL presenting with altered mental status and systemic organ dysfunction.
CASE SUMMARY
A 61-year-old male patient presented with flu-like symptoms and a high fever. He experienced rapid clinical deterioration with liver, kidney failure, and shock despite rapid antibiotic administration and supportive care. A broad infectious workup was negative. Intracranial imaging revealed nonspecific changes to the corpus callosum suspicious for vasculitis. Renal biopsy was non-diagnostic. After further progression of his symptoms, the family elected to withdraw care and the patient died shortly thereafter. Post-mortem analysis revealed clear multi-organ involvement by IVLBCL, prompting re-examination of the ante-mortem renal biopsy that also identified IVLBCL involvement.
CONCLUSION
IVLBCL is a rare disease. Communication with specialties and early biopsy is critical to establishing the diagnosis and initiating therapy.
Core tip: Early diagnosis is critical to altering the disease course of intravascular large B-cell lymphoma (IVLBCL). A triad of B symptoms, organ dysfunction, and an elevated lactate dehydrogenase should prompt consideration of IVLBCL and early biopsy of affected tissues for rapid diagnosis and treatment. Close communication with pathology in cases of suspected IVLBCL is critical in evaluating for this rare and evasive diagnosis.
