Primary bone lymphoma presenting as fever of unknown origin

Abstract

We presented a case of primary bone lymphoma (PBL) which demonstrated fever of unknown origin. Although the diagnosis of PBL is difficult, up to 11% of patients with fever of unknown origin were later diagnosed with PBL, which suggests that there may be many cases of misdiagnosis. This case study emphasizes the importance of careful diagnosis for fever of unknown origin especially when the patient has bone pain.

Primary Bone Lymphoma: A Review of the Literature with Emphasis on Histopathology and Histogenesis

“…The clinical features of PBL are generally unspecific, frequently leading to a delay in diagnosis, and, thus, a high index of suspicion is required [ 7 , 18 ]. The most common symptom of PBL is local bone pain in the affected area, which is not relieved by rest and has been characterized as insidious, intermittent and progressively worsening [ 2 , 3 , 4 , 7 , 9 , 15 , 18 , 19 , 20 , 21 , 22 , 23 ]. Other less common manifestations include soft tissue edema, palpable mass, pathological fracture, restricted range of motion in the involved articulation and “B” symptoms, namely fever, night sweats and unintentional weight loss [ 2 , 3 , 4 , 8 , 11 , 18 , 19 , 22 , 23 , 24 , 25 ].…”

“…The latter are present in a minority of patients and are less frequent in PBL compared to systemic lymphomas [ 2 , 24 ]. Nonetheless, PBL should be considered in cases of fever of unknown origin, especially in the presence of bone pain [ 20 ]. Spinal cord compression and hypercalcemia due to osteolysis with related symptoms, such as lethargy, somnolence and constipation, are two major complications [ 2 , 9 , 22 , 23 , 24 ].…”

“…PBL can develop in any part of the skeleton, although is most common in the femur, humerus, tibia, spine and pelvis [ 2 , 3 , 4 , 7 , 8 , 9 , 10 , 17 , 20 , 21 , 22 , 24 , 31 ]. Other less common sites of occurrence include the skull, forearm, scapula, clavicle, patella, hands and feet [ 3 , 4 , 9 , 10 , 17 , 21 , 25 ].…”

“…The histological and immunohistochemical appearance of PBL has been reported in a number of studies [ 2 , 3 , 4 , 7 , 8 , 9 , 14 , 15 , 16 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ,…”

“…The findings of articles published before 2006 [ 16 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] were summarized in our previous review about PBL [ 78 ]. Herein, we analyze the histological and immunohistochemical features of PBL described in subsequent studies [ 2 , 3 , 4 , 7 , 8 , 9 , 14 , 15 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 69 , 70 , 71 , 72 ...…”