Related Experiment Video
Updated: May 29, 2026
Skin Biopsy for Diagnosing Discoid Lupus Erythematosus
Published on: June 10, 2025
Early diagnosis of recurrent diffuse large B-cell lymphoma showing intravascular lymphoma by random skin biopsy
Akira Kasuya1, Hideo Hashizume, Masahiro Takigawa
1Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan. casuaki@hama-med.ac.jp
Insights
A rare cancer, intravascular B-cell lymphoma, was diagnosed in a patient with fever of unknown origin. Random skin biopsy proved crucial for early detection and successful treatment.
Area of Science:
- Hematology
- Oncology
- Dermatology
Background:
- Diffuse large B-cell lymphoma (DLBCL) survivor presented with fever of unknown origin.
- Elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP) suggested an inflammatory or malignant process.
- Imaging studies ruled out lymphadenopathy and tumor formation, complicating the differential diagnosis.
Observation:
- A 66-year-old male with a history of treated DLBCL presented with a 2-week history of fever.
- Routine imaging did not reveal lymphadenopathy or tumors.
- Random skin biopsy of normal-appearing abdominal skin was performed.
Findings:
- Skin biopsy revealed extensive infiltration of CD20(+), CD79a(+), CD3(-) atypical lymphoid cells within the subcutaneous vessel lumens.
- These findings confirmed the diagnosis of intravascular B-cell lymphoma (IBCL).
- Treatment with rituximab plus cyclophosphamide, adriamycin, vincristine, and prednisolone (R-CHOP) led to fever resolution and normalization of LDH and CRP.
Implications:
- Random skin biopsy is a valuable diagnostic tool for early detection of IBCL.
- Prompt diagnosis and treatment of IBCL can lead to favorable outcomes.
- This case highlights the importance of considering rare presentations of lymphoma recurrence.
Abstract:
A 66-year-old man was admitted to our hospital presenting 2 weeks' history of fever of unknown origin with elevated levels of lactate dehydrogenase and C-reactive protein. Six years before this episode, he had developed diffuse large B-cell lymphoma, which had been successfully treated with chemoradiation. While recurrence of diffuse large B-cell lymphoma was suspected, there was neither lymphadenopathy nor tumor formation by the imaging study. Random biopsy from normal-appearing abdominal skin showed extensive infiltration of CD20(+), CD79a(+), CD3(-) atypical lymphoid cells in the lumen of vessels in subcutaneous tissues. These findings led us to the diagnosis of intravascular B-cell lymphoma. Following rituximab plus cyclophosphamide, adriamycin, vincristine and prednisolone therapy, high fever subsided, and lactate dehydrogenase and C-reactive protein levels returned to the normal range. In conclusion, random skin biopsy is useful for the early diagnosis of intravascular B-cell lymphoma.
