Generalized Edema and Telangiectasia: Unusual Presentation of Intravascular Large B-cell Lymphoma

Intravascular large B-cell lymphoma is characterized by clusters of large neoplastic B cells within small blood vessels, most commonly in the dermis and subcutis. There is no nodal or parenchymal involvement until late in the disease, and its endothelial tropism is responsible for the variable clinical features. We report the case of a 51 year-old man who presented with fever, altered mental status, generalized edema, and profound telangiectasia. The diagnosis was made by a skin biopsy from the right thigh. Histology revealed ectatic vessels in the superficial dermis and large atypical lymphoid cells filling the small blood vessels in the deep dermis. Immunohistochemical staining showed strongly positive results for CD45 and CD79a. This was a rare case of intravascular large B-cell lymphoma with generalized edema and telangiectasia as the only cutaneous manifestation.