Intravascular large B-cell lymphoma of the central nervous system, a masquerader on radiography and clinical presentation: A case report

Abstract A 72-year-old woman presented to the emergency department with progressive left hemiparesis, confusion, urinary incontinence and frequency. She was hospitalized multiple times during the last 6 months for stroke work-up and seizure management necessitating intubation and ICU admission. An MRI done at that time revealed multiple foci of abnormal diffusion restriction in both cerebral hemispheres. Further vasculitis work-up was positive for ANA and RNP A and the patient was started on high dose prednisone therapy without significant improvement. A CT with contrast done during the latest admission showed a hyper-dense enhancing nodule in the right frontal lobe suggestive of metastasis. She underwent a right-sided frontal image guided needle biopsy. The pathology was consistent with intravascular large B cell lymphoma (IVLBCL). IVLBCL limited to the central nervous system (CNS) is extremely rare [1], with only few cases reported in the literature [2]. It is usually misdiagnosed as cerebral infarction on radiology and clinical presentation. Definite diagnosis necessitates tissue biopsy. Hereby we present the 9th case of biopsy proven IVLBCL limited to the CNS mimicking cerebral infarction and inflammatory conditions on radiography and by clinical presentation