Intravascular lymphoma preceded by urinary retention and diagnosed by random skin biopsy

A 53-year-old man was hospitalized for the scrutinization of urinary disturbance. Although vertebral X-ray did not show bone destruction, magnetic resonance imaging (MRI) revealed multiple lesions in thoracic and lumbar vertebrae. Bone marrow aspiration and biopsy of the ilium showed no abnormality. Bone marrow biopsy of the fifth lumbar vertebra was performed, and the diagnosis of diffuse large B cell lymphoma was made. As subacute ascending myelopathy of flaccid paraparesis developed, intravascular lymphoma was suspected. Random skin biopsy was then performed from normal-appearing skin. Hematoxylin-eosin staining allowed the visualization of the intravascular lymphoma lesions, and staining with anti-CD20 monoclonal antibody highlighted the atypical lymphoid cells in the capillary vessels. These findings led to the diagnosis of intravascular large B cell lymphoma (IVLBCL). The patient responded well to combination chemotherapy containing rituximab. Intravascular lymphoma should be suspected in any patients with the unexplained progressive neurologic dysfunction, and a random skin biopsy is useful for early diagnosis and treatment.