Case Report: Neuropsychological Profile of a Patient With Intravascular Large B-Cell Lymphoma Following Infection and Vaccination

Abstract

Objective: Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive lymphoma that can have heterogeneous central nervous system involvement and cerebrovascular complications. The development of IVLBCL can be fatal. Although relatively rare, the development of specific clinical syndromes, such as IVLBCL, has been implicated following infection and vaccination. To our knowledge, this is the first comprehensive neuropsychological evaluation assessing neurocognitive and psychological status after IVLBCL diagnosis.

Methods: The current study presents a right-handed mid-60-year-old male with a university-level education, who was diagnosed with IVLBCL following viral vector SARS-CoV-2 vaccination. He presented with a complex medical history including antiphospholipid syndrome, deafness (prior to cochlear implant), and cardiovascular complications secondary to lymphoma. Brain magnetic resonance imaging showed parietal, frontal, and cerebellar infarcts; encephalomalacia; and periventricular deep chronic ischemic changes. A comprehensive neuropsychological evaluation was completed.

Results: In consideration of an individual with an estimated above-average baseline, his neurocognitive profile demonstrated impairments across multiple domains that were more lateralized to the non-dominant hemisphere including visual attention, visual processing speed, visuo-construction, memory, motor dexterity, and right-sided ataxia (e.g., dysmetria). Clinical elevations for depression, hopelessness, and anxiety were also found.

Conclusions: The current study highlights a novel cognitive profile of IVLBCL and comorbidities with the patient having more predominant nondominant hemispheric-related deficits. There was evidence of disruption to visual processing networks, largely consistent with neuroimaging lesions. The current case also describes the unique experience of an individual coping with a rare condition, especially when resulting in functional decline (e.g., loss of audition). Implications are discussed.

Keywords: COVID-19; Cancer; Cognitive functioning; IVLBCL; Intravascular large B-cell lymphoma.

Fig. 1

Brain magnetic resonance imaging (MRI) in radiological orientation from his first neuroimaging study following acute onset of symptoms showing bilateral scattered foci of acute/subacute infarcts in the biparietal and bifrontal lobes and mild periventricular and subcortical white matter signal abnormalities.

Fig. 2

Images from follow-up brain MRI in radiological orientation, approximately 1 year and 2 months following neuroimaging timepoint 1, demonstrating the accumulation and evolution of vascular events across his medical course. The above images demonstrate parietal and frontal chronic infarcts, bilateral periventricular deep chronic ischemic changes, and right cerebellar chronic infarcts involving the anterior and inferior aspects of the cerebellar hemisphere.