Intravascular lymphoma presenting as a specific pulmonary embolism and acute respiratory failure: a case report

Abstract

Introduction: The occurrence of an intravascular lymphoma with severe pulmonary involvement mimicking pulmonary embolism is described.

Case presentation: A 38-year-old man was referred to our intensive care unit with acute respiratory failure and long lasting fever. Appropriate investigations failed to demonstrate any bacterial, viral, parasitic or mycobacterial infection. A chest computed tomography scan ruled out any proximal or sub-segmental pulmonary embolism but the ventilation/perfusion lung scan concluded that there was a high probability of pulmonary embolism. The cutaneous biopsy pathology diagnosed intravascular lymphoma.

Conclusion: Intravascular lymphoma is a rare disease characterized by exclusive or predominant growth of neoplastic cells within the lumina of small blood vessels. Lung involvement seems to be common, but predominant lung presentation of this disease is rare. In our patient, urgent chemotherapy, along with adequate supportive care allowed complete recovery.

Figure 1

Perfusion lung scan before (left panel) and after (right panel) cancer chemotherapy.

Figure 2

Cutaneous punch biopsy showing an intravascular lymphocytic infiltrate (a) composed of large atypical cells (b) that were CD20 positive on an immunohistochemical stain (c).