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  • Vasculitis on brain angiography is not always vasculitis: intravascular large B-cell lymphoma mimicking central nervous system vasculitis

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Reminder of important clinical lesson
CASE REPORT
Vasculitis on brain angiography is not always vasculitis: intravascular large B-cell lymphoma mimicking central nervous system vasculitis
  1. Corbin Rayfield,
  2. Lester Mertz,
  3. Katalin Kelemen and
  4. Fawad Aslam
  1. Mayo Clinic, Phoenix, Arizona, USA
  1. Correspondence to Dr Corbin Rayfield, rayfield.corbin{at}mayo.edu

Abstract

A 68-year-old man, with a history of non-Hodgkin’s lymphoma in remission, was admitted for homonymous hemianopsia, headaches and subacute progressive cognitive decline. Imaging revealed brain infarcts and angiography suggested vasculitis. A brain biopsy, however, revealed an intravascular large B-cell lymphoma (IVLBL). Central nervous system (CNS) vasculitis and IVLBL of the brain are extremely rare diseases that can have an almost identical clinical presentation. Angiographic findings are very similar but usually are reported as compatible with vasculitis. Brain biopsy or a random skin biopsy are crucial in diagnosing IVLBL as the accuracy of angiographic findings for CNS vasculitis is low.

  • neurology
  • neuroimaging
  • neurooncology
  • CNS cancer
  • vasculitis

https://doi.org/10.1136/bcr-2019-230753

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    Footnotes

    • Contributors CR, LM, KK and FA all participated in the drafting and editing of the manuscript. FA completed final revision and made the decision for submission. CR drafted the initial manuscript and completed editing. LM and KK provided expert commentary and review.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.