Progressive multifocal cerebral infarction from intravascular large B cell lymphoma presenting in a man: a case report

Abstract

IntroductionIntravascular lymphoma is rare, and may present as ischemic stroke. Diagnosis is difficult due to the non-specific presentation and lack of lymphadenopathy, thus leading to frequent instances of autopsy-proven diagnosis. To the best of our knowledge, this is the first report of progressive stroke from intravascular lymphoma diagnosed antemortem by random skin biopsy.Case presentationA 42-year-old Thai man presented to our hospital with progressive multifocal cerebral infarction. Despite taking aspirin (300 mg/day), his neurological symptoms worsened. During admission, he developed an unexplained fever and hypoxemia. Magnetic resonance angiography clearly showed patency of all cerebral arteries including the internal carotid and vertebrobasilar arteries. Echocardiography, an antiphospholipid antibody test, cerebrospinal fluid cytology and a bone marrow study were normal. Other laboratory test results showed an elevated lactate dehydrogenase level, nephrotic range proteinuria (3.91 g/day), hypoalbuminemia (1.9 g/dL), a very low high-density lipoprotein level (7 mg/dL) and hypertriglyceridemia (353 mg/dL). Because of suspected vasculitis, pulse methylprednisolone was given with transiently minimal improvement. A random skin biopsy from both thighs revealed intravascular large B cell lymphoma. Chemotherapy was not given due to our patient having ventilator associated pneumonia. He died 10 days after the definite diagnosis was established.ConclusionOne etiology of stroke is intravascular lymphoma, in which random skin biopsy can be helpful for antemortem diagnosis.

Hypertrophic Olivary Degeneration and Holmes’ Tremor Secondary to Bleeding of Cavernous Malformation in the Midbrain

“…Hypertrophic olivary degeneration (HOD) is a rare form of neuronal degeneration that occurs secondary to injuries that disrupt normal function of the afferent fibers to the inferior olivary nucleus (ION) as part of the dentate-rubro-olivary pathways (triangle of Guillain-Mollaret). 1 The first description of HOD was published by Oppenheim in 1887, and the development of HOD was further described by Guillain and Mollaret in 1931. 2,3 Insults to this pathway are commonly related to vascular disease, either infarction or hemorrhage.…”

“…However, HOD may occur after head trauma, tumor, demyelinating or degenerative diseases, and after surgical manipulation. 1,4 HOD is best observed using magnetic resonance imaging (MRI), where it appears as an enlargement of the ION, with increased signal on T2-weighted images. 5 Symptomatic palatal tremor is a well-defined movement disorder that appears after lesions involving the Guillain-Mollaret triangle and is classically associated with HOD.…”

Clinical Reasoning: A 28-year-old man with progressive gait disturbance and encephalopathy

“…Nephrotic syndrome has also been documented. 5 Our patient's nephrotic syndrome was thought secondary to focal segmental glomerulosclerosis, the most common form of nephrotic syndrome in sickle cell disease, but biopsy was not pursued secondary to the patient's encephalopathy.…”

Linfoma primário e secundário do sistema nervoso central: aspectos de imagem na ressonância magnética convencional e funcional

“…There are some other less common presentations of CNS lymphomas such as lymphomatoid granulomatosis (10) , intravascular lymphoma (11,12) and lymphomatosis cerebri (13) , which may represent a diagnostic challenge to radiologists. Another impor-0100-3984 © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Primary and secondary lymphoma of the central nervous system.…”