Rapidly progressive neurological deterioration without magnetic resonance imaging abnormalities: intravascular lymphoma.

نویسندگان

  • Anna van Rhenen
  • Niels W C J van de Donk
چکیده

A 50-year-old man with a negative medical history presented with aphasia and influenza-like symptoms over the course of 2 days. He was transferred to our university hospital because of unexplained encephalopathy with mutism and apraxia. Laboratory analysis revealed an elevated lactate dehydrogenase level of 1282 U/L (reference range, ,250 U/L) and a normal leukocyte count with normal differentiation. Cerebrospinal fluid examination was negative for an infection, and only a few normal T cells were present. Surprisingly, magnetic resonance imaging of the brain (panel A) did not show any abnormalities, and computed tomography also failed to show lymphadenopathy. Unfortunately, the patient developed respiratory insufficiency after a seizure and was then intubated. A bone marrow smear showed large blast-like cells with prominent nucleoli (panel B), and immunophenotyping showed a small CD45 weak population (2%) positive for CD19, CD20, and HLA-DR and negative for CD34, CD10, T markers, and myeloid markers.

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عنوان ژورنال:
  • Blood

دوره 123 19  شماره 

صفحات  -

تاریخ انتشار 2014