A 66-year-old woman presented with a two-month history of lethargy and anorexia. A physical examination revealed reticular telangiectasia on the cheeks and trunk, which appeared as reddish-purple spots (Picture 1, 2). Laboratory tests revealed elevated lactate dehydrogenase (1,582 U/L) and soluble interleukin-2 receptor (5,304 U/mL) levels. A random skin biopsy of the right lower abdomen and bilateral thighs revealed atypical cells filling the vessels (Picture 3), negative for CD3, and positive for CD20 (Picture 4) and CD5. Based on these findings, intravascular large B-cell lymphoma (IVLBCL) was definitively diagnosed. The patient died of multi-organ failure on hospital day16.
Picture 1.
Picture 2.
Picture 3.
Picture 4.
Skin lesions occur in approximately 40% of IVLBCL cases, approximately 20% of which manifest reticular telangiectasia (1) stemming mainly from the obstruction and consequent dilation of small blood vessels by infiltrating lymphoma cells (2). Although the present diagnosis was confirmed by random skin biopsy findings, reticular telangiectasia should be biopsied whenever IVLBCL is suspected.
Consent to publish the details of the case was obtained from the patient.
The authors state that they have no Conflict of Interest (COI).
Acknowledgments
The authors thank James R. Valera for his assistance in editing the manuscript, Dr. Azusa Orihara (Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center) for her cooperation with the patient's care, Dr. Mariko Hao (Department of Dermatology, Tokyo Metropolitan Tama Medical Center) for performing the skin biopsies, and Dr. Haruka Okada (Department of Pathology, Tokyo Metropolitan Tama Medical Center) for conducting the pathological tissue diagnosis and providing thoughtful comments on the present case.
References
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