Myocardial infarction as an uncommon clinical manifestation of intravascular large cell lymphoma

Abstract

Intravascular large cell lymphoma (IVL) is a very rare variant of non-Hodgkin's lymphoma presenting with puzzling clinical manifestations. There is a predilection for the central nervous system, but the tumour often affects also skin, lung, and kidneys while lymphadenopathy and hepatosplenomegaly are usually absent. Myocardial infarction due to IVL has not been reported so far. We here report on a 56-year-old patient who was admitted to our hospital with fever and clinical signs of erysipelas. He had a 6-month history of "collagen vasculitic disease" treated with prednisolone and azathioprine. He received antibiotic treatment, but after transient improvement fever recurred with generalized seizures and myocardial infarction, which required transfer to the intensive care unit where the patient died with signs of an acute cardiogenic shock. Autopsy revealed a generalized high-grade B cell lymphoma of IVL type affecting and obstructing small vessels of a variety of tissues including heart, brain and lungs. The tumorous obliteration of small intramyocardial vessels had led to an acute ischaemia with infarction and subsequent signs of myocardial insufficiency. To the best of the authors' knowledge myocardial infarction as a leading symptom of IVL has not been described.

Intravascular Lymphoma: The Oncologist's “Great Imitator”

“…Proof of this supposition, however, can only come from extensive evaluation of integrin expression in IVL cases from disparate organs. Beyond these major presentations, there are single case reports of IVL presenting primarily in almost every organ system; as interstitial lung disease [18], adrenal failure [19], pulmonary hypertension [20], nephrotic syndrome [21], myocardial infarction [22], and symmetric polyarthritis [23].…”

Simultaneous Thrombosis of the Mesenteric Artery and Vein as a Novel Clinical Manifestation of Intravascular Large B-Cell Lymphoma

“…In relation to this possibility, Bauer et al [16] and Sumer et al [17] reported 2 exceptional IVLBCL cases in which fatal multiembolic strokes including myocardial infarction developed.…”

Linfoma intravascular de células B grandes: hallazgos clínicos y morfológicos en un caso con desenlace fatal

“…Otras formas de presentación poco frecuentes incluyen insufi ciencia suprarrenal, hipertensión pulmonar, síndrome nefrótico, infarto de miocardio y enfermedad pulmonar intesticial. La fi ebre en tanto se observa hasta en 45% de los casos, explicado por la producción de citocinas proinfl amatorias por parte de los linfocitos neoplásicos 1,[16][17][18][19][20][21][22] . Anemia (63%), LDH y b2-microglobulina elevada (82% y 86% respectivamente) son las alteraciones más comunmente observada al laboratorio, menos frecuentemente trombocitopenia y leucopenia (24 y 29%, respectivamente) 1,2,6 ; presentando el caso reportado anemia (29,9%) y leve trombocitopenia (106.300).…”