A Case of Intravascular Large B-cell Lymphoma (IVLBCL) with no Abnormal Findings on Chest Computed Tomography Diagnosed by Random Transbronchial Lung Biopsy

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  • Kaku Norihito
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Seki Masafumi
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Doi Seiji
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Hayashi Tomayoshi
    Department of Clinical Laboratory, Nagasaki University Hospital
  • Imanishi Daisuke
    Department of Hematology, Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University
  • Imamura Yoshifumi
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Kurihara Shintaro
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Miyazaki Taiga
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Izumikawa Koichi
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Kakeya Hiroshi
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Yamamoto Yoshihiro
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Yanagihara Katsunori
    The Second Department of Internal Medicine, Nagasaki University Hospital Department of Clinical Laboratory, Nagasaki University Hospital
  • Tashiro Takayoshi
    The Second Department of Internal Medicine, Nagasaki University Hospital
  • Kohno Shigeru
    The Second Department of Internal Medicine, Nagasaki University Hospital

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Abstract

A 58-year-old woman was admitted with refractory fever despite receiving broad-spectrum antibiotics. She had hypoxemia, severe anemia, elevated levels of serum lactic dehydrogenase and soluble interleukin-2 receptor, and a positive direct Coombs test, which suggested an underlying autoimmune hemolytic anemia (AIHA). Chest computed tomography (CT) showed no abnormal findings, but she had hypoxia, and her alveolar-arterial oxygen difference (A-aDO2) was increased. A random transbronchial lung biopsy (TBLB) was performed, and pathological analysis showed massive proliferation of tumor cells in the lumina of the small vessels. Intravascular large B-cell lymphoma (IVLBCL) was diagnosed, and her general status improved after chemotherapy.<br>

Journal

  • Internal Medicine

    Internal Medicine 49 (24), 2697-2701, 2010

    The Japanese Society of Internal Medicine

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