title: Intravascular large B-cell lymphoma complicated by invasive pulmonary aspergillosis: a rare presentation.
abstract: We describe a patient with persisting fevers, a progressive pulmonary infiltrate, and high levels of serum lactate dehydrogenase. No underlying cause for these changes was found prior to her death despite extensive investigations. Postmortem tissue revealed invasive pulmonary aspergillosis and subsequent brain examination revealed vascular changes in keeping with intravascular large B-cell lymphoma (IVLBCL). On review, subtle yet extensive lymphomatous infiltrates involved the vasculature of multiple other organs, including the lungs. Aspergillosis is a relatively rare presenting feature of lymphoproliferative disorders, and IVLBCL is a rare subtype of diffuse large B-cell non-Hodgkin's lymphoma with, to our knowledge, very few case reports to date. Lymphoma should be considered in patients presenting with pneumonitis with bilateral lung infiltrates on imaging, with a high serum level of lactate dehydrogenase.
authors.affiliation: Department of Anatomical Pathology, School of Medicine, University of Western Sydney Sydney, New South Wales, Australia.
authors.forename: Tamadur
authors.initials: T
authors.lastname: Mahasneh
authors.affiliation: Department of Respiratory Medicine, Liverpool Hospital, University of New South Wales Sydney, New South Wales, Australia.
authors.forename: Zinta
authors.initials: Z
authors.lastname: Harrington
authors.affiliation: Department of Respiratory Medicine, Liverpool Hospital, University of New South Wales Sydney, New South Wales, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Williamson
authors.affiliation: Department of Surgery, Nepean Hospital, University of Sydney Sydney, New South Wales, Australia.
authors.forename: Darweesh
authors.initials: D
authors.lastname: Alkhawaja
authors.affiliation: Department of Forensic Medicine, University of Sydney Sydney, New South Wales, Australia.
authors.forename: Jo
authors.initials: J
authors.lastname: Duflou
authors.affiliation: Department of Anatomical Pathology, School of Medicine, University of Western Sydney Sydney, New South Wales, Australia.
authors.forename: Joo-Shik
authors.initials: JS
authors.lastname: Shin
keywords: Cough; intravascular lymphoma; lactate dehydrogenase; pulmonary aspergillosis; pyrexia