Intravascular Large B-Cell Lymphoma Case Report: A Diagnostic Challenge

Area of Science:

• Oncology
• Neurology
• Hematology

Background:

• Intravascular large B-cell lymphoma (IVLBCL) is a rare non-Hodgkin lymphoma characterized by malignant lymphocytes confined to the lumina of blood vessels.
• Diagnosis can be challenging due to nonspecific symptoms and the need for specialized biopsies.

Observation:

• A 66-year-old female presented with recurrent strokes over three months, with initial workup for autoimmune vasculitis and hypercoagulable states being negative.
• Bone marrow and lymph node biopsies did not reveal lymphoma.
• An excisional muscle biopsy identified atypical CD20+ lymphoid cells within small blood vessels, leading to the diagnosis of IVLBCL.

Findings:

• The patient was treated with systemic chemotherapy, central nervous system (CNS)-directed therapy, and autologous stem cell transplant.
• This case underscores the diagnostic difficulties and potential complications associated with delayed identification of IVLBCL.

Implications:

• Highlights the importance of considering rare diagnoses like IVLBCL in patients with unexplained neurological events.
• Emphasizes the critical role of thorough diagnostic workup, including specific biopsies, for accurate and timely diagnosis.
• Discusses management strategies and potential complications, informing clinical practice for similar challenging cases.