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Multiple Spontaneous Remissions of Intravascular Large B-Cell Lymphoma before a Definitive Diagnosis: A Case Report
Keisuke Tatsuoka1, Minako Mori1, Tatsuya Yamanaka1
1Department of Hematology, Japanese Red Cross Otsu Hospital, Japan.
Insights
This case study highlights intravascular large B-cell lymphoma (IVLBCL) with three spontaneous remissions before diagnosis. Repeated self-limited relapses are exceptionally rare in IVLBCL.
Area of Science:
- Oncology
- Hematology
- Pathology
Background:
- Intravascular large B-cell lymphoma (IVLBCL) is a rare non-Hodgkin lymphoma.
- Diagnosis can be challenging due to nonspecific symptoms and variable presentation.
Purpose of the Study:
- To report an unusual case of IVLBCL with repeated spontaneous remissions.
- To highlight the diagnostic challenges and clinical course of IVLBCL.
Main Methods:
- Case report of a 60-year-old male patient.
- Clinical presentation, laboratory findings (elevated LDH, sIL-2R), and diagnostic procedures (skin biopsy, bone marrow examination) were analyzed.
- Serial observations of disease course including spontaneous remissions and relapses.
Main Results:
- The patient experienced three episodes of spontaneous remission over ten months.
- Initial diagnostic tests, including random skin biopsy and bone marrow examination, were inconclusive.
- Persistent symptoms and sustained elevation of LDH led to a definitive diagnosis via skin biopsy.
Conclusions:
- IVLBCL can present with recurrent, self-limited spontaneous remissions, a highly unusual clinical course.
- The case underscores the importance of persistent clinical suspicion and repeated investigations for diagnosing IVLBCL.
- This presentation challenges typical diagnostic paradigms for IVLBCL.
Abstract:
We report a case of intravascular large B-cell lymphoma (IVLBCL) characterized by three episodes of spontaneous remission before a definitive diagnosis. A 60-year-old man presented with headache and cognitive impairment, with elevated serum lactate dehydrogenase (LDH) and soluble interleukin-2 receptor levels. Although IVLBCL was suspected, a random skin biopsy and bone marrow examination yielded nonspecific findings, and the symptoms resolved spontaneously. Similar self-limited relapses occurred twice in this patient. Ten months after onset, persistent fever, neurological deterioration, hypoxemia, and sustained LDH elevation developed, and IVLBCL was finally diagnosed by a random skin biopsy. This case illustrates the extremely rare phenomenon of the repeated spontaneous remission in IVLBCL.