SHM Converge Scientific Abstract ePoster Gallery-An Atypical Presentation of Intravascular Large B Cell Lymphoma

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This case report describes an atypical presentation of intravascular large B-cell lymphoma (ILBL), a rare and aggressive lymphoma with a poor prognosis. A 74-year-old woman presented with six months of worsening fatigue, shortness of breath, and generalized swelling (anasarca). Her laboratory workup showed anemia, severe thrombocytopenia, signs of hemolysis, kidney dysfunction, and elevated liver tests, but common causes such as thrombotic microangiopathy, autoimmune hemolysis, infection, and bone marrow malignancy were not supported by testing. Imaging revealed mediastinal and axillary lymphadenopathy, splenomegaly, and diffuse edema.<br /><br />The diagnosis was ultimately made after renal biopsy, which showed atypical large lymphoid cells filling the capillary lumina of the glomeruli, with strong CD20 positivity on immunohistochemistry, confirming renal involvement by ILBL. The patient also had nephrotic-range proteinuria, an unusual presentation for this disease.<br /><br />The report highlights that ILBL typically presents without a visible tumor mass and often lacks circulating malignant cells in peripheral blood. Symptoms vary depending on organ involvement, but fever of unknown origin is most common. Renal involvement is rare, and laboratory findings are often nonspecific, which can delay diagnosis. Definitive diagnosis requires histopathologic examination of affected tissue. Standard treatment includes R-CHOP chemotherapy.<br /><br />The key message is that hospitalists and clinicians should maintain a high index of suspicion for ILBL when patients have unexplained multi-organ abnormalities, since early biopsy and diagnosis are critical for timely treatment.

Asset Subtitle

Mridula P. Talari

Meta Tag

Author List Camelia Chirculescu, Haytham Adada, Ibrahim Nakhoul, Martin Cook, Mridula P. Talari

Category Clinical Vignettes

Concept Intravascular Large B-Cell Lymphoma

Concept Histopathology

Concept Immunohistochemistry

Concept R-CHOP

Concept Blood Vessel Lumen

Distinguished Non-Finalist

Presenter Organization Johnston Memorial Hospital

Presenting Author Mridula P. Talari

Track Adult

Keywords

intravascular large B-cell lymphoma

ILBL

renal biopsy

CD20 positivity

nephrotic-range proteinuria

anemia

thrombocytopenia

hemolysis

lymphadenopathy

splenomegaly

Intravascular Large B-Cell Lymphoma

Histopathology

Immunohistochemistry

R-CHOP

Blood Vessel Lumen