Multiorgan failure caused by intravascular lymphoma

Abstract

Sir, Intravascular lymphoma (IVL) is a rare aggressive non-Hodgkin's lymphoma with varied clinical presentation and propensity of multiorgan involvement predominantly affects elderly patients.1,,2 Nearly 300 cases have been notified worldwide but its prevalence is certainly under-estimated. We report a fatal case of IVL presenting as a multiorgan failure and review the current literature with the aim to increase awareness and prompt early detection of this highly rare lymphoma. A 72-year-old healthy man was hospitalized for progressive asthenia and dementia evolving during the last month. On admission, the patient complained of myalgia and diarrhea. Biological abnormalities includes: neutrophil count = 1.1 × 109/1, lymphocyte count = 0.5 × 109/1, platelet count =89 × 109/1, aspartate aminotransferase = 5N, ferritine = 4N, myoglobine level = 4N and creatinine = 140 µmol/1 with mixt proteinuria = 0.29 g/day. Bacterial assays and serology for HIV, B and C hepatitis virus, EBV, CMV and autoimmune investigations were negative. Sternal medullar exam was considered as normal. Abdominal sonography was normal. One week later, the patient presented a febrile confusional syndrome with severe dyspnea. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed no abnormalities. cerebro-spinal fluid (CSF) sample revealed hyperproteinorachia 1.6 g/1, 12 leukocytes/mm3 (70% of lymphocytic cells) without …