[Fever and nonspecific pulmonary lesions--a rare differential diagnosis].
METHODS
A 70-year-old woman presented with rapidly increasing weakness, night sweats, progressive dyspnea and daily fever up to 39 C. 30 years before early stage breast cancer had successfully been treated by resection.


METHODS
Blood tests revealed moderate normocytic anemia and a considerable elevation of the serum level of lactate dehydrogenase (LDH). The differential blood count was normal. Chest radiography showed interstitial infiltrates. Computed tomography revealed reticular shadows and ground-glass opacities which on histological examination were attributed to intravascular lymphoma (IVL) of B cell lineage.


METHODS
Treatment with eight cycles of the R-CHOP 14 regimen (rituximab, cyclophophamide, doxorubicine, vincristine, prednisone; interval: 14 days) resulted in complete remission with rapid resolution of constitutional symptoms. 7 months later the IVL relapsed, again with fever and an elevation of the LDH level. Bone marrow biopsy revealed intravascular infiltration by lymphoma cells. Salvage treatment with six courses of a methotrexate-containing protocol led to a second complete remission.


CONCLUSIONS
Nonspecific constitutional symptoms, a large variety of potential clinical presentations and the infrequency of the disease render the ante mortem diagnosis of an intravascular lymphoma difficult. Treatment follows the same principles as in nodal aggressive non-Hodgkin's lymphomas.
Bollinger
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CR
Zentrum für Innere Medizin, Klinik für Hämatologie, Universitätsklinikum Essen, Essen. claudia.bollinger@uni-due.de
Theegarten
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D
Dührsen
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Metz
K A
KA
D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D001856:Bone Marrow Examination; D001999:Bronchoscopy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008727:Methotrexate / Q000008:administration & dosage; D011014:Pneumonia / Q000175:diagnosis; D011241:Prednisone / Q000627:therapeutic use; D012129:Respiratory Function Tests; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods; D014057:Tomography, X-Ray Computed; D014750:Vincristine / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007770:L-Lactate Dehydrogenase; D011241:Prednisone; D008727:Methotrexate