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01.12.2011 | Case report | Ausgabe 1/2011 Open Access

Journal of Medical Case Reports 1/2011

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

Zeitschrift:
Journal of Medical Case Reports > Ausgabe 1/2011
Autoren:
Pornpong Jitpratoom, Patcharawan Yuckpan, Panitta Sitthinamsuwan, Wattanachai Chotinaiwattarakul, Yingyong Chinthammitr
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-5-24) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

PJ and PY were the primary physicians taking care of our patient and contributed to data collection and drafting of the manuscript. PS, the pathologist consultant, performed the histological examination of skin, revised the manuscript and prepared the figures of pathological findings. WC, the neurologist consultant, analyzed and interpreted the neurological data. YC, the hematologist consultant, analyzed and interpreted the data, and was a major contributor in writing the discussion and revision of the manuscript. All authors read and approved the final manuscript.

Abstract

Introduction

Intravascular 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 presentation

A 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.

Conclusion

One etiology of stroke is intravascular lymphoma, in which random skin biopsy can be helpful for antemortem diagnosis.

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