A Rare Presentation of Intravascular Lymphoma in an HIV patient

Abstract

BackgroundIntravascular lymphoma (IVL) is an extremely rare form of non‐Hodgkin lymphoma characterized by almost exclusive growth of neoplastic lymphocytes within the blood vessel lumen. IVL is morphologically characterized in most instances by large cells with B‐cell lineage. There is a paucity of literature describing the association between HIV and intravascular lymphoma.Case Presentation43‐year‐old female with HIV presented with weakness involving her left arm and leg. Physical examination showed decreased strength in the left lower extremity and impaired sensory perception in the right lower extremity. Neuroimaging revealed a lesion in the spinal cord at the level of C5/6 and diffuse leptomeningeal and patchy enhancement in the left frontal lobe. CSF analysis was significant for positive JC virus PCR. The patient was considered to have progressive multifocal leukoencephalopathy; however, the clinical and neuroimaging findings did not support this diagnosis. Leptomeningeal biopsy showed focal infiltrations of large atypical lymphocytes confined within blood vessels with immunohistochemistry being positive for CD3. The morphological findings were consistent with intravascular diffuse large B cell lymphoma.ConclusionThis case highlights a rare occurrence of HIV infection and intravascular lymphoma and its inherent atypical presentation and diagnostic challenges.