Rare Case of Refractory Shock Secondary to Large B Cell Lymphoma

A previously healthy 69-year-old female admitted to the hospital with refractory hypotension fevers and diarrhea. She had two prior hospitalizations with similar presentations and no clear etiology could be identified. During her current hospitalization, she was admitted to the intensive care unit (ICU) due to refractory shock. Despite an extensive work up with multiple subspecialty consultation, the patient ultimately transitioned to comfort care. Autopsy report revealed extensive large b-cell lymphocyte involvement within the vasculature of the majority of her organs. This case of intravascular large B-cell lymphoma (ILBCL) exemplifies the necessity to include it on a broadened differential when shock becomes refractory.