A Case of Intravascular Large B-cell Lymphoma (IVLBCL) with no Abnormal Findings on Chest Computed Tomography Diagnosed by Random Transbronchial Lung Biopsy

Abstract

A 58-year-old woman was admitted with refractory fever despite receiving broad-spectrum antibiotics. She had hypoxemia, severe anemia, elevated levels of serum lactic dehydrogenase and soluble interleukin-2 receptor, and a positive direct Coombs test, which suggested an underlying autoimmune hemolytic anemia (AIHA). Chest computed tomography (CT) showed no abnormal findings, but she had hypoxia, and her alveolar-arterial oxygen difference (A-aDO2) was increased. A random transbronchial lung biopsy (TBLB) was performed, and pathological analysis showed massive proliferation of tumor cells in the lumina of the small vessels. Intravascular large B-cell lymphoma (IVLBCL) was diagnosed, and her general status improved after chemotherapy.

Indication for Random Skin Biopsy for the Diagnosis of Intravascular Large B Cell Lymphoma

“…IVLBCL often affects the lungs, and chest CT findings are interstitial infiltrates, patchy consolidations or ground glass opacities [13]. In our patient with lung DLBCL (case 5), chest CT revealed a nodular lesion.…”

PET-negative pulmonary intravascular large B cell lymphoma diagnosed by a random transbronchial lung biopsy

“…Although the involvement in the lung is often detected at autopsy, early diagnosis is difficult [4]. Several cases have been diagnosed as pulmonary IVLBCL by TBLB [5]. In the current case, we successfully obtained early diagnosis of pulmonary IVLBCL by random TBLB despite no abnormal accumulation of FDG in bilateral lung fields.…”

CNS intravascular large cell lymphoma in a patient with autoimmune hemolytic anemia

“…The B‐lymphocytes are thought to be of postgerminal center type and their predilection for intravascular growth is believed to result from defects in adhesion molecules CD29, CD54 and CD11a . Although association of NHL with AIHA has been described in the literature, the specific association of IVLCL with AIHA is exceptional, with only one previously reported case . While the mechanistic connection between the two diseases is not completely understood, it is probably similar to that of NHL and AIHA in general.…”

“…The prognosis is poor, with an average survival of only 13 months; frequently, the diagnosis is only made at autopsy. The co‐occurrence of non‐Hodgkin lymphomas (NHLs) and various autoimmune diseases has been described, but IVLCL association with autoimmune hemolytic anemia (AIHA) has only been reported once . Here, we present the second example of IVLCL‐AIHA co‐occurrence, this time with a neurologic presentation.…”