Case Report

Volume: 7 | Issue: 6 | Published: Aug 17, 2023 | Pages: 132 - 136 | DOI: 10.24911/ejmcr/173-1679317215

Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader


Authors: Shu Ann Hon orcid logo , Jie Siang See , Jack Son Wee , Yu Jin Tee , Ehram Jamien , Hamdi Achok , Soo Min Lim


Article Info

Authors

Shu Ann Hon

Department of Internal Medicine, Hospital Sultanah Aminah, Johor Bahru, Malaysia

orcid logo ORCID

Jie Siang See

Department of Internal Medicine, Hospital Sultanah Aminah, Johor Bahru, Malaysia

Jack Son Wee

Department of Internal Medicine, Hospital Sultanah Aminah, Johor Bahru, Malaysia

Yu Jin Tee

Department of Radiology, Hospital Sultanah Aminah, Johor Bahru, Malaysia

Ehram Jamien

Department of Pathology, Hospital Sultanah Aminah, Johor Bahru, Malaysia

Hamdi Achok

Department of Internal Medicine, Hospital Sultanah Aminah, Johor Bahru, Malaysia

Soo Min Lim

Department of Internal Medicine, Hospital Sultanah Aminah, Johor Bahru, Malaysia.

Publication History

Received: March 21, 2023

Revised: June 17, 2023

Accepted: June 17, 2023

Published: August 17, 2023


Abstract


Background: Intravascular large B-cell lymphoma (IVLBCL) is infrequent and aggressive, clinically depicted by an almost exclusive growth of large cells within the lumen of blood vessels of all sizes. The clinical manifestations are diverse, encompassing many non-specific signs and symptoms such as fever of unknown origin, neurological symptoms, and skin lesions. Case Presentation: We report a case of a 49-year-old lady with unusual IVLBCL of the central nervous system. She presented with rapidly progressive dementia preceded by seizures and a short history of altered sensorium. There were no cutaneous lesions. Plain computed tomography brain showed no significant abnormalities. Cerebrospinal fluid analysis was normal except for mildly raised protein. Antinuclear antibody was positive 1:320 but the remaining autoimmune workups were negative. Electroencephalogram showed cortical dysfunction with occasional sharp wave at the right frontoparietal region. Other dementia workups were unremarkable. Magnetic resonance imaging brain revealed non-enhanced biparietal gyri hyperintensities which may represent encephalitis changes. She was empirically treated for viral encephalitis, however, there were still recurrent seizures despite adequate anti-seizure medications with minimal improvement of symptoms. Subsequent admissions noticed bicytopenia with elevated lactate dehydrogenase. Bone marrow aspirations and trephine biopsy disclosed High-Grade Mature B Cell Lymphoma germinal center B-cell Type. She was subsequently managed by the hematology team and started with conventional rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy. Fortunately, she is currently on the road to recovery. Conclusion: High index of suspicion is warranted to diagnose early in order to have a better prognosis.

Keywords: IVLBCL, rapidly progressive dementia, seizures, altered sensorium, bicytopenia, green


Pubmed Style

Shu Ann Hon, Jie Siang See, Jack Son Wee, Yu Jin Tee, Ehram Jamien, Hamdi Achok, Soo Min Lim. Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader. EJMCR. 2023; 17 (August 2023): 132-136. doi:10.24911/ejmcr/173-1679317215

Web Style

Shu Ann Hon, Jie Siang See, Jack Son Wee, Yu Jin Tee, Ehram Jamien, Hamdi Achok, Soo Min Lim. Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader. https://ejmcr.com/articles/1062 [Access: December 25, 2024]. doi:10.24911/ejmcr/173-1679317215

AMA (American Medical Association) Style

Shu Ann Hon, Jie Siang See, Jack Son Wee, Yu Jin Tee, Ehram Jamien, Hamdi Achok, Soo Min Lim. Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader. EJMCR. 2023; 17 (August 2023): 132-136. doi:10.24911/ejmcr/173-1679317215

Vancouver/ICMJE Style

Shu Ann Hon, Jie Siang See, Jack Son Wee, Yu Jin Tee, Ehram Jamien, Hamdi Achok, Soo Min Lim. Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader. EJMCR. (2023), [cited December 25, 2024]; 17 (August 2023): 132-136. doi:10.24911/ejmcr/173-1679317215

Harvard Style

Shu Ann Hon, Jie Siang See, Jack Son Wee, Yu Jin Tee, Ehram Jamien, Hamdi Achok, Soo Min Lim (2023) Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader. EJMCR, 17 (August 2023): 132-136. doi:10.24911/ejmcr/173-1679317215

Chicago Style

Shu Ann Hon, Jie Siang See, Jack Son Wee, Yu Jin Tee, Ehram Jamien, Hamdi Achok, Soo Min Lim. "Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader." 17 (2023), 132-136. doi:10.24911/ejmcr/173-1679317215

MLA (The Modern Language Association) Style

Shu Ann Hon, Jie Siang See, Jack Son Wee, Yu Jin Tee, Ehram Jamien, Hamdi Achok, Soo Min Lim. "Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader." 17.August 2023 (2023), 132-136. Print. doi:10.24911/ejmcr/173-1679317215

APA (American Psychological Association) Style

Shu Ann Hon, Jie Siang See, Jack Son Wee, Yu Jin Tee, Ehram Jamien, Hamdi Achok, Soo Min Lim (2023) Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader. , 17 (August 2023), 132-136. doi:10.24911/ejmcr/173-1679317215