Intravascular large B-cell lymphoma causing hypopituitarism and respiratory failure due to infiltration into pulmonary capillaries

Abstract

We report a rare case of intravascular large B-cell lymphoma (IVLBCL) with hypopituitarism and respiratory failure. A man in his 80s presented with hypotension and respiratory failure but was unsuccessfully treated for septic shock. Biological investigations were performed, and he was diagnosed with hypopituitarism due to insufficient secretion of anterior pituitary hormone. Although his condition temporarily improved following hormone replacement therapy, he eventually died of progressive respiratory failure. The lymphoma was only discovered during the autopsy, where it was observed to have spread to the pituitary gland and lung capillaries. Therefore, we concluded that the lymphoma had caused respiratory failure and hypopituitarism. The patient was thus diagnosed with IVLBCL posthumously. In conclusion, IVLBCL can cause hypopituitarism and respiratory failure due to pituitary and pulmonary capillary invasion by lymphoma cells.

Keywords: Haematology (incl blood transfusion); Pituitary disorders.

Figure 1

CD20 staining positivity in a hepatic lymph node (red-brown).

Figure 2

Infiltration of lymphoma cells into the lung capillaries visualised using H&E staining (arrow head).

Figure 3

(A) Lymphoma diffuse infiltration into the anterior pituitary gland visualised using H&E staining. (B) CD20 staining positivity in the anterior pituitary gland (red-brown).