SHM Converge Scientific Abstract ePoster Gallery-Progressive Bilateral Leg Edema Due to Intravascular Large B-Cell Lymphoma

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This case describes an 81-year-old woman with one month of progressive bilateral leg edema and one week of pain and inflammation in both lower legs. She had no fever, weight loss, heart murmurs, or jugular venous distention. Examination showed pitting edema with tenderness in both legs.<br /><br />Laboratory tests revealed anemia, thrombocytopenia, low albumin, elevated LDH (1314 U/L), elevated CRP, elevated D-dimer, and markedly increased soluble IL-2 receptor. Chest X-ray was normal. Contrast-enhanced CT showed soft tissue swelling in both lower legs without deep vein thrombosis or inferior vena cava thrombosis. Bone marrow biopsy was normal.<br /><br />A skin biopsy confirmed intravascular large B-cell lymphoma (IVLBCL), with immunostaining positive for CD20 and CD79a, and negative for CD3 and CD10. IVLBCL can cause vascular obstruction from tumor cells within blood vessels and may produce edema, inflammatory symptoms, and thrombosis-like findings. Elevated LDH is a key clue, and random skin biopsy has high diagnostic value.<br /><br />The patient’s edema improved within three weeks after starting chemotherapy, and there was no recurrence during 8 months of follow-up.<br /><br />Key message: unexplained acute or subacute edema, especially with high LDH, should raise suspicion for IVLBCL, and random skin biopsy can be useful for diagnosis.

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Risa Hirata

Meta Tag

Author List Hidetoshi Aihara, Kiyoshi Shikino, Masaki Tago, Motoshi Fujiwara, Naoko E. Katsuki, Noriko Ide, Orisa Nakashima, Risa Hirata, Shizuka Yaita, Shun Yamashita, So Motomura, Tomoyo Nishi, Yoshinori Tokushima

Category Clinical Vignettes

Concept Intravascular Large B-Cell Lymphoma

Concept Leg Edema

Concept Random Skin Biopsy

Concept Inflammatory Pain

Concept Pleural Fluid Lactate Dehydrogenase

Distinguished Non-Finalist

Presenter Organization Saga University Hospital

Presenting Author Risa Hirata

Track Adult

Keywords

intravascular large B-cell lymphoma

bilateral leg edema

elevated LDH

skin biopsy

CD20 positive

soluble IL-2 receptor

thrombocytopenia

anemia

lower leg inflammation

random skin biopsy

Intravascular Large B-Cell Lymphoma

Leg Edema

Random Skin Biopsy

Inflammatory Pain

Pleural Fluid Lactate Dehydrogenase