SHM Converge Scientific Abstract ePoster Gallery-A Deadly Coat of Many Colors: Intravascular Large B-Cell Lymphoma

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This case describes intravascular large B-cell lymphoma (IVLBCL), a very rare and highly aggressive lymphoma with subtle, nonspecific presentation. A 64-year-old man with psoriatic arthritis on etanercept, coronary artery disease, adrenal insufficiency, and alcohol use disorder presented with weakness, fatigue, night sweats, and transient slurred speech. He was initially hemodynamically stable and neurologically intact, with labs showing anemia, marked inflammation, elevated ferritin and CRP, but no clear diagnosis. Peripheral smear, SPEP, and bone marrow biopsy were unrevealing.<br /><br />Over the next month, he had recurrent admissions for transient aphasia, worsening thrombocytopenia and anemia, and later sudden shortness of breath. Workup showed rising LDH and low haptoglobin, leading to a tentative diagnosis of hemolytic uremic syndrome; he was started on eculizumab with minimal benefit. Because of progressive respiratory failure and reduced DLCO, a lung biopsy was performed, which revealed IVLBCL, double/triple-hit negative. He was started on R-CHOP and briefly developed neutropenia treated with pegfilgrastim.<br /><br />The patient declined intrathecal chemotherapy and later developed seizures. Neuroimaging showed a right occipital/parietal mass with edema and intracranial hemorrhage, consistent with CNS involvement, and he ultimately died from CNS complications.<br /><br />The discussion emphasizes that IVLBCL often affects small and medium vessels, can evade routine bone marrow biopsy, and commonly presents with fever, night sweats, elevated ferritin/LDH, cytopenias, and hemophagocytosis. Because of its rarity and variable presentation, diagnosis is frequently delayed. The case highlights the importance of maintaining a high index of suspicion to avoid prolonged hospitalizations, unnecessary testing, and delayed treatment.

Asset Subtitle

Muftah Mahmud

Meta Tag

Author List Muftah Mahmud, Neychelle Rocca, Roshini Pradeep

Category Clinical Vignettes

Concept Intravascular Large B-Cell Lymphoma

Concept Extranodal Lymphoma

Concept Fever

Concept Cytopenia

Concept Poor Prognosis

Distinguished Non-Finalist

Presenter Organization Midwestern University Internal Medicine Residency Program,Verde Valley Medical Center

Presenting Author Muftah Mahmud

Track Adult

Keywords

intravascular large B-cell lymphoma

IVLBCL

lymphoma

hemolytic uremic syndrome

eculizumab

R-CHOP

central nervous system involvement

cytopenias

elevated LDH

lung biopsy

Intravascular Large B-Cell Lymphoma

Extranodal Lymphoma

Fever

Cytopenia

Poor Prognosis