PMC10439831_01
Chest radiography and computed tomography (CT) during hospitalization. (a) Chest radiography on admission showing ground-glass opacity in bilateral lung fields. (b) Chest CT on admission showing bilateral diffuse, hazy ground-glass infiltrates throughout the lungs. (c) Abdominal CT on admission showing mild hepatosplenomegaly. (d) Chest radiography on day 20 showing marked improvement in lung shadowing. (e) Chest CT on day 27 showing marked improvement in lung shadowing.
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Chest radiography and CT showed diffuse interstitial lung shadows (Figures 1(a) and 1(b)), while abdominal CT revealed mild hepatosplenomegaly (Figure 1(c)). The chest shadows improved dramatically on radiography on day 20 (Figure 1(d)) and on CT on day 27 (Figure 1(e)).
Time course of treatment of intravascular large B-cell lymphoma. NPPV: noninvasive positive pressure ventilation; HFNC: high-flow nasal cannula; Alb: albumin; Hb: hemoglobin; Plt: platelet; mPSL: methylprednisolone; PSL: prednisolone; LVFX: levofloxacin; TAZ/PIPC: tazobactam/piperacillin; R-CHOP: rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. The patient's respiratory condition did not improve after administering antibiotics or high steroid doses. NPPV and HFNC were used for respiratory support. Blood tests revealed a further decline in platelet count, albumin, and hemoglobin levels. On day 8, a random skin biopsy was performed; on day 12, the patient was diagnosed with IVLBCL after a skin biopsy. On day 14, the patient received R-CHOP therapy. After one chemotherapy cycle, the patient's dyspnea gradually improved, and oxygen therapy was discontinued on day 24. The patient was discharged on day 30.
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Treatment was initiated with methylprednisolone (1000 mg/day) for 3 days, followed by tazobactam piperacillin (18 g/day) and levofloxacin (500 mg/day) for the next 6 days, providing coverage for atypical pathogens (Figure 2).
Hematoxylin-eosin (H&E) staining and CD20 immunostaining of intravascular B lymphocytes from the thigh skin biopsies (400x). (a) Atypical cells are packed in abnormal vessels (H&E staining, 20x). (b) Immunohistochemistry of atypical CD20-positive cells (20x).
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Random skin and bone marrow biopsies were performed on day 8, and thigh skin biopsies sampled on day 12 revealed large, atypical lymphoma cells within the capillaries (Figure 3(a)) positive for CD20 (Figure 3(b)) but negative for CD3, CD5, and CD10.