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Abstract

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Article in Japanese

Case Report

A case of intravascular large B-cell lymphoma presented hypoxemia with normal chest CT findings

Masahiro Sawada  Hiroki Amano 

Department of Respiratory Medicine, Gifu Red Cross Hospital

ABSTRACT

A 76-year-old woman was admitted because of hypoxemia. She had been complaining of dyspnea for 2 months. Both plain and enhanced CT of the chest showed no abnormality. Her serum LDH level was markedly elevated. Though lung ventilation scintigraphy showed no abnormality, lung perfusion scintigraphy disclosed multiple perfusion defects. A fluorodeoxyglucose (FDG) positron emission tomography scan revealed slight uptake of FDG in bilateral dorsal lung regions. We performed a transbronchial lung biopsy (TBLB) but made no accurate diagnosis. After 2 weeks of TBLB, she developed neurological symptoms, such as convulsion, anarthria, gait disturbance, and disturbance of consciousness. She died 5 months after admission. We later restudied her TBLB specimen and found the proliferation of many CD20-positive atypical cells in capillary vessels of the alveolar septa, which led us to identify this case as an intravascular large B-cell lymphoma (IVLBCL). Although IVLBCL is a rare disease, it is necessary to include IVLBCL in differential diagnosis in cases of hypoxemia with normal chest CT findings and elevated serum LDH.

KEYWORDS

Intravascular large B-cell lymphoma  Normal chest CT findings  Dyspnea 

Received 20 Dec 2014 / Accepted 13 Apr 2015

AJRS, 4(4): 293-297, 2015

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