Fever of Unknown Origin due to Primary Hepatic Diffuse Large B-cell Lymphoma: A Case Report

Abstract

We present a rare case of primary hepatic lymphoma. An 82-year-old female patient presented with altered mental status, and fever. Her labs were significant for abnormal liver functions with markedly elevated lactate dehydrogenase. All infectious and auto-immune workup was negative. Imaging studies were only significant for hepatosplenomegaly, and no liver masses were detected. A liver biopsy was diagnostic of CD5+ CD20+ diffuse large b-cell lymphoma of the liver. Chemotherapy was planned with rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Unfortunately, the patient died before initiation of therapy. This case would highlight the importance of early liver biopsy in patients with abnormal liver functions and with no clear explanation, even if there were no discrete masses on computed tomography (CT) or magnetic resonance imaging (MRI). Lymphomas and other infiltrative processes should be considered in the differential diagnosis in such cases.

De Novo CD5+ Primary Gastrointestinal Diffuse Large B-Cell Lymphoma: Challenges With Treatment and Clinical Course

“…Rare cases of involvement of liver has also been reported. 18 Almost all of the patients did not show positivity for HIV or HTLV1. Ten percent of the cases showed BCL2 rearrangements, while 25% of the cases had BCL6 rearrangement.…”

Diffuse large B-cell lymphoma presenting as reversible intrapulmonary arteriovenous shunts with hypoxia, fever and progressive jaundice: a case report and literature review

“…Up to a third of DLBCL may arise from extra-nodal sites, most commonly gastrointestinal tract, skin and soft tissues, bone, or genitourinary tract, rarely spleen, liver, lung and others [ 9 ]. Primary splenic lymphoma is rare with a reported incidence of less than 1% while primary hepatic lymphoma is 0.4% of all extra-nodal NHL [ 10 , 11 ]. Jaundice can be the only clinical manifestation of primary hepatosplenic DLBCL in a case report [ 12 ].…”

Clinical management and susceptibility of primary hepatic lymphoma: A cases-based retrospective study

“…Clinical manifestations might be insignificant, but after the onset of acute liver failure, the patient’s condition could easily collapse. Researchers have reported that when a patient experiences jaundice, general weakness or acute liver failure that leads to hepatic encephalopathy, they could die[ 14 , 15 ]. In our study, deceased patients enduring heavy tumor burden had more severe symptoms on admission and then deteriorated very quickly within months.…”