Intravascular large B-cell lymphoma presenting with altered mental status: A case report

Figure 1 Case timeline. MRI: Magnetic resonance imaging; ED: Emergency department.

Figure 2 Magnetic resonance imaging brain findings. Evolution of central nervous system changes highlighting the corpus callosum involvement and parenchymal abnormalities related to intravascular large B-cell lymphoma. A: Normal magnetic resonance imaging (MRI) taken August 21, 2017; B: MRI brain 3 m later at presentation revealing splenium enhancement also known as the “boomerang sign[8]”; C: MRI taken 18 d following the MRI shown in B with continued evolution of splenium enhancement as well as progressive parenchymal enhancement posteriorly.

Figure 3 Histopathologic analysis. A: Post-mortem renal parenchyma high power view demonstrating lymphovascular cells distending the lumen of a vessel lined by epithelial cells (original magnification 40×); B: Immunohistochemical stain from an ante-mortem renal biopsy for CD20+ highlighting lymphocytes restricted to vascular spaces (original magnification 20×); C: Post-mortem pituitary section revealing extensive lymphocyte involvement of lymphovascular spaces (original magnification 20×); D: Intravascular large B-cell lymphoma within cerebral vessels with focal sludging (original magnification 20×).