Intravascular lymphoma with diffuse FDG uptake in the bone marrow by 18FDG-PET/CT

Abstract

A 58 years old woman presented with prolonged fever with headache and significant weight loss
without abnormal finding on physical examination. The initial laboratory investigations revealed hemoglobin 9.3 g/dL, evidence of autoimmune hemolytic anemia on peripheral blood smear, urine protein 205 mg/24 hours, positive ANA, MRI brain showed subacute infarction at right-sided of pons. She was treated with high dose steroid as autoimmune disease but still had high fever. The patient developed dyspnea on exertion, pitting
edema and severe hypoalbuminemia. The bone marrow aspiration showed increasing of histiocytes without
abnormal cells detected. The CT chest include abdomen was unremarkable. The FDG-PET/CT scan was done
and revealeddiffuse increased bone marrow uptake and splenomegaly with diffused uptake. Then, pathological
report of bone marrow and random skin biopsy demonstrated the large B cell within small vasculature with CD20 positive compatible with intravascular large B cell lymphoma