[A case of acute progressive myelopathy due to intravascular large B cell lymphoma diagnosed with only random skin biopsy].
A 64-year old woman was admitted to our hospital with subacute onset paraparesis and sensory disturbance at a level below Th10. Spinal MRI showed a T2 weighted high-signal intensity lesion at a level from Th5 to Th12, and an abdominal CT showed a mass in the left kidney. Her paraparesis deteriorated rapidly, and administration of high dose methyl prednisolone followed by oral steroid therapy was started before obtaining of a definitive diagnosis. However her symptoms did not improve after the beginning of treatment. At the same time, a bone marrow puncture, and biopsies from kidney and spinal cord were performed. These biopsies demonstrated no clues, diagnostically. Therefore a random skin biopsy was performed at the five sites on the 17th day after the steroid dosage end. From this, pathological evidence of intravascular large B cell lymphoma (IVLBCL) was shown. For rapid diagnosis of acute myelopathy with mass lesion of another organ due to IVLBCL, a biopsy is taken not only from spinal cord or mass lesions, but is also taken of multiple sites in skin randomly. This must be performed without a delay before a sudden deterioration of neurologic symptoms can occur from ischemic events not responsive to steroid therapy.
Department of Neurology and Stroke Treatment, Kyoto First Red Cross Hospital.
Hidekazu
H
Yamazaki
Keisuke
K
Imai
Masashi
M
Hamanaka
Takehiro
T
Yamada
Kazuma
K
Tsuto
Atsushi
A
Yamamoto
Yasuhiko
Y
Tsutumi
D000208:Acute Disease; D001706:Biopsy / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D012867:Skin / Q000473:pathology*; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology; D019043:Vascular Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology