[Intravascular large B-cell lymphoma presenting as subacute progressive myelopathy]

The clinical manifestations of intravascular large B-cell lymphoma (IVLBCL) are highly variable and include constitutional B symptoms, neurological findings, and skin lesions. We report the case of a 64-year-old male patient who presented with myelopathy as a sole manifestation of IVLBCL. He had experienced progressive bilateral leg weakness along with bladder and rectal dysfunction for several months. He did not have non-neurological symptoms such as fever, night sweats, and weight loss at presentation. Blood tests, cerebrospinal fluid analysis, random skin biopsy, and bone marrow biopsy showed no evidence of lymphoproliferative disease. Subsequently, the patient developed a fever, and his LDH and soluble interleukin-2 receptor levels were elevated. PET/CT showed ground-glass opacity of the lung with associated FDG avidity. Transbronchial lung biopsy confirmed a diagnosis of IVLBCL. The patient received 6 cycles of R-CHOP combined with 2 cycles of high-dose methotrexate. His symptoms gradually improved with the chemotherapy, and PET/CT after completion of the treatment showed a complete metabolic response.