Antemortem diagnosis with multiple random skin biopsies and transbronchial lung biopsy in a patient with
intravascular large B-cell lymphoma, the so-called Asian variant lymphoma
BMJ Case Reports 2014; doi:10.1136/bcr-2013-202661
Tomotaka Nishizawa, Takeshi Saraya, Haruyuki Ishii, Hajime Goto
Summary
A 59-year-old, previously healthy man presented to our hospital, with a 3-month history of high fever,
nocturnal sweating and exertional dyspnoea. Aggressive diagnostic procedures such as multiple random skin biopsies
and transbronchial lung biopsy (TBLB) led to an antemortem diagnosis of intravascular large B-cell lymphoma (IVLBCL),
which showed abundant CD20 atypical lymphocytes aggregated in lumina of small vessels. The 29 cases diagnosed with IVLBCL
during their lifetime by TBLB were reviewed. Their clinical features included respiratory symptoms
(hypoxaemia, dyspnoea and dry cough) and persistent fever. IVLBCL patients show various radiological patterns
(ground glass opacities, multiple centrilobular nodules, interlobular septal thickening, interstitial shadows
and thickening of bronchovascular bundles), suggesting lymphatic or haematological spread.
Antemortem diagnosis of IVLBCL is difficult, but a multidisciplinary approach, with aggressive multiple random skin biopsies
and/or TBLB, should be considered in patients with respiratory symptoms that are refractory to antibiotics or prednisolone treatment.
intravascular large B-cell lymphoma, the so-called Asian variant lymphoma
BMJ Case Reports 2014; doi:10.1136/bcr-2013-202661
Tomotaka Nishizawa, Takeshi Saraya, Haruyuki Ishii, Hajime Goto
Summary
A 59-year-old, previously healthy man presented to our hospital, with a 3-month history of high fever,
nocturnal sweating and exertional dyspnoea. Aggressive diagnostic procedures such as multiple random skin biopsies
and transbronchial lung biopsy (TBLB) led to an antemortem diagnosis of intravascular large B-cell lymphoma (IVLBCL),
which showed abundant CD20 atypical lymphocytes aggregated in lumina of small vessels. The 29 cases diagnosed with IVLBCL
during their lifetime by TBLB were reviewed. Their clinical features included respiratory symptoms
(hypoxaemia, dyspnoea and dry cough) and persistent fever. IVLBCL patients show various radiological patterns
(ground glass opacities, multiple centrilobular nodules, interlobular septal thickening, interstitial shadows
and thickening of bronchovascular bundles), suggesting lymphatic or haematological spread.
Antemortem diagnosis of IVLBCL is difficult, but a multidisciplinary approach, with aggressive multiple random skin biopsies
and/or TBLB, should be considered in patients with respiratory symptoms that are refractory to antibiotics or prednisolone treatment.
