Intravascular lymphoma as an unusual cause of multifocal cerebral infarctions discovered on FDG-PET/CT.
Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive variant of diffuse large B-cell lymphoma with frequent involvement of the central nervous system. Its atypical presentation often delays the diagnosis and due to its aggressive behaviour, the diagnosis is made post-mortem in half of the cases. We report a case of a 67-year-old male patient presenting with speech difficulties and balance disturbances in whom a magnetic resonance imaging (MRI) scan showed multiple lesions of the white matter, denoted as embolic infarctions. He was treated for a suspected endocarditis with antibiotics, but deteriorated neurologically with persistent fever. A consecutive FDG -PET /CT revealed an increased uptake in the adrenals, of which a biopsy showed IVLB CL. The patient was successfully treated with systemic R-CHOP with intrathecal methotrexate and achieved complete remission after six cycles of chemotherapy. The potential role of FDG-PET/CT is illustrated by this case leading to an exceptional diagnosis of IVLBCL.
Boslooper
K
K
Department of Internal Medicine, Martini Hospital, Groningen, the Netherlands.
Dijkhuizen
D
D
van der Velden
A W G
AW
Dal
M
M
Meilof
J F
JF
Hoogenberg
K
K
D000368:Aged; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D019043:Vascular Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18