A CASE OF DISSEMINATED INTRAVASCULAR LYMPHOMA PRESENTING AS SEPSIS WITH MULTIORGAN FAILURE

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Intravascular lymphoma (IVL) is a rare subtype of proliferating in the lumen causing small vessel occlusion. Antemortem diagnosis difficult. The majority cases are diagnosed from autopsy. We report patient with IVL who presented sepsis unknown source complicated by multiorgan failure. CASE PRESENTATION: A 58-year-old male hypertension and chronic obstructive lung disease fever for 3 weeks was found to be hypotensive. Laboratory investigation remarkable platelet count 84,000 per microliter, serum creatinine mg/dl, aspartate aminotransferase 50 units liter (U/L), total bilirubin 5 ferritin 1265 microgram liter, lactate dehydrogenase 2051 U/L. Blood, respiratory urine cultures were negative. CT abdomen pelvis did not reveal septisis source. Transthoracic echocardiogram showed preserve ejection fraction without tamponade. Hemodynamic data pulmonary artery catheter wedge pressure 14, mixed venous oxygen saturation 72. He septic shock treated broad spectrum antimicrobials including Meropenem, Vancomycin Micafungin. started on continuous renal replacement therapy. His clinical course continued deteriorate. family decided withdraw life support. expired hospital day 11. An autopsy revealed intravascular large B-cell lymphoma. DISCUSSION: an extremely extranodal lymphoma, predominantly affecting elderly patients. incidence remains due its rarity. presentation variable, ranging asymptomatic, constitutional B symptoms failure caused can presence cells within small-to-medium blood vessels. difficult lack pathognomonic features or tumor markers. Symptoms could mimic other more common diseases since manifestations heterogeneous which lead delayed missed diagnosis. aggressive usually disseminated at time Treatment systemic chemotherapy. CONCLUSIONS: While it should considered differential unexplained no clear cause. requires high index suspicion suspected patients suggestive relevant findings may early treatment better outcomes. REFERENCE #1: Bouzani M et al., "Disseminated b-cell lymphoma: clinicopathological outcome three anthracycline-based immunochemotherapy," Oncologist, vol. 11, no. 8, pp. 923–928, 2006. #2: Ferreri AJ, Campo E, Seymour JF; International Extranodal Lymphoma Study Group (IELSG). presentation, natural history, management prognostic factors series 38 cases, special emphasis 'cutaneous variant'. Br J Haematol. 2004 Oct;127(2):173-83. #3: Murase T, Yamaguchi M, Suzuki R al. (IVLBCL): clinicopathologic study 96 reference immunophenotypic heterogeneity CD5. Blood. 2007 Jan 15;109(2):478-85. DISCLOSURES: No relationships Maythawee Bintvihok, source=Web Response Parneet Dhaliwal, Joseph Guileyardo, Adam Hayek, Adan (Adam) Mora,