A case of intravascular large B-cell lymphoma – Our clinical experience

Fever of unknown origin is always a diagnostic challenge in establishing etiology. A gentleman his 70s presented with complaints fever and dry cough for 2 months duration. We proceeded contrast imaging the thorax abdomen which revealed mild hepatomegaly. Bone marrow examination bone culture 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT). aspirate smears were hypercellular around 50% atypical lymphoid cells plasmacytoid bizarre morphology few multilobed nuclei. biopsy predominantly sinusoidal involvement by neoplastic cells. On immunohistochemistry, tumor positive CD45, CD79a, CD20, MUM1 negative CD5, CD10, BCL6. Ki-67 was 60% FDG PET/ CT diffusely increased uptake both axial appendicular skeleton (SUVmax 5.06) 3.67) noted spleen. As intravascular large B-cell lymphoma highly aggressive non-Hodgkin high risk central nervous system involvement, we treated it chemoimmunotherapy (R-CHOP) intrathecal methotrexate. After clinical follow 3 months, patient developed relapsed soft-tissue swelling over right leg. The two cycles R-DHAP had progressive disease started on Ibrutinib, Lenalidomide, Rituximab (2 cycles). Post cycles, switched to acalabrutinib based therapy. 1 month acalabrutinib-lenalidomide-rituximab therapy, progression succumbed disease.