Fever of unknown origin revealed to be primary splenic lymphoma: A rare case report with review of the literature

Sun, Pan-Ge; Cheng, Bei; Wang, Jinfeng; He, Ping

doi:10.3892/mco.2016.1110

Cited by 9 publications

(5 citation statements)

References 38 publications

(52 reference statements)

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“…the most common presenting symptoms of psL are fever, malaise, left upper quadrant pain, weight loss and night sweats. [1] abdominal computerized tomography (Ct) performed on our patient showed massive splenomegaly (21cm), lymph nodes in the spleen hilum, without hepatomegaly or other concerns.…”

Section: Discussionmentioning

confidence: 69%

“…The term 'fever of unknown origin' (FUO) was first introduced by Petersdorf and Beeson in 1961 based on an analysis of 100 cases, and it was defined as recurrent fever >38.3°C, lasting for >3 weeks, remaining undiagnosed after 1 week of in-hospital evaluation. [1] the etiologies of classic FUo mainly include infections, malignancies, non-infectious inflammatory diseases, and miscellaneous causes, while some cases remain undiagnosed. [2,3] primary splenic lymphoma (psL) is a rare malignant lymphoma with an incidence of ~1% among patients with non-Hodgkin lymphoma (NHL), although the spleen is involved in approximately half of the cases of Hodgkin's disease and one-third of NHLs as part Deputy Editors of systemic disease.…”

Section: Introductionmentioning

confidence: 99%

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The Key Role of Splenectomy in Fever of unknown Origin which Resulted to be B-cell primary Splenic Lymphoma.

Muco,

Osmenaj,

Bode

et al. 2023

AJTES

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Background: The term ‘fever of unknown origin’ (FUO) was first introduced by Petersdorf and Beeson in 1961, and it is defined as recurrent fever >38.3°C, lasting for >3 weeks, remaining undiagnosed after 1 week of in-hospital evaluation. The etiologies of classic FUO include mainly infections, malignancies, non-infectious inflammatory diseases, and miscellaneous causes, while some cases remain undiagnosed. Primary splenic lymphoma (PSL) is a rare malignant lymphoma. In many cases, splenectomy is the treatment of choice for massive splenomegaly. Case presentation: A 54-year-old woman presented with a history of high fever up to 39°C, sweating, fatigue, and weight loss for one month. She had been treated by her family physician with antibiotics (cephalosporin) for 10 days but without improvement. On admission, the patient had palpable splenomegaly but no palpable lymphadenopathy. The patient had increased markers of inflammation. The indicators of autoimmune disease were all negative. Screening for specific infectious diseases and the blood cultures all came out negative. Abdominal computerized tomography (CT) revealed an enlarged spleen. The splenectomy was performed and the spleen was sent for histological analysis. Meanwhile, the patient was subject to a complex treatment. Histological and immunohistochemical analysis confirmed the diagnosis of diffuse large B-cell non-Hodgkin lymphoma with diffuse red pulp infiltration. Afterward, the patient underwent systemic chemotherapy. Conclusion: We strongly suggest that clinicians should have a high index of suspicion for malignancies in cases with FUO. Sometimes splenectomy can be the key to solving the problem.

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

The Key Role of Splenectomy in Fever of unknown Origin which Resulted to be B-cell primary Splenic Lymphoma.

Muco,

Osmenaj,

Bode

et al. 2023

AJTES

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“…The changes of the etiology proportion of FUO may be attributed to diagnostic advances, particularly the improvement of imaging and microbiological studies. Among the neoplastic causes of FUO, malignant lymphomas are the most common 1 .…”

Section: Discussionmentioning

confidence: 99%

“…A sustained unexplained fever >38.3°C lasting for >3 weeks without an established diagnosis despite intensive diagnostic evaluation is referred to as Fever of Unknown Origin (FUO). FUO remains a clinical challenge for physicians, as it may be attributed to a wide range of disorders, mainly infections, malignancies, non-infectious inflammatory diseases and miscellaneous diseases 1 . The four categories of potential etiology of FUO are classic, nosocomial, immune deficient, and human immunodeficiency virus-related.…”

Section: Introductionmentioning

confidence: 99%

Clinico-Pathological Evaluation of Fever More Than Three Weeks : A Cross Sectional Study in A Tertiary Care Hospital

Haidar

2019

Chatt Maa Shi Hosp Med Coll J

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Background: Fever is a common clinical presentation of a number of diseases. A sustained unexplained fever >38.3°C lasting for >3 weeks without an established diagnosis despite intensive diagnostic evaluation is referred to as Fever of Unknown Origin (FUO). Fever more than three week remains a clinical challenge for physicians, as it may be attributed to a wide range of disorders, mainly infections, malignancies, non-infectious inflammatory diseases and miscellaneous diseases. The evaluation of the condition of a patient with fever of unknown origin requires a knowledge of those disorders that produce this syndrome, an awareness of the potential significance of subtle findings in the history and physical examination, and an appreciation of the value in this clinical setting of specific diagnostic procedures. In this report, we review these aspects of fever of unknown origin and outline a diagnostic approach to the persistently febrile patient. Objective: Purpose of this study was to clinico-pathological evaluation of fever more than three weekswith its aetiology and clinical spectrum. Methods: This cross-sectional study was conducted amongst adult males and females patients suffering from the fever of more than three weeks over period of two years at Combined Military Hospital, Chattogram Cantonment from January, 2016 to December, 2017. Sample was selected by purposive sampling technique. Inclusion criteria were H/O fever or body temperature greater than 38.3°C on several occasions, accompanied by more than three weeks of illness and failure to reach a diagnosis after one week of inpatient investigation. Total 72 cases were enrolled according to selection criteria. Routine hematological, biochemical, imaging test were done and mid-stream urine samples were collected from these patients and subjected to culture. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigation were done meticulously. Results: In this study age of participants at entry was >20years, mean age was 38.04±11.08. Female sex were significant number, sex ratio (F: M) was 1.25:1. Most common clinical presentations were persistent fever and generalized weakness (100.0%), followed by arthralgia/ arthritis (51.3%) anorexia (44.4%) and headache (34.7%). The focused fever of unknown origin diagnostic approach is based on hallmark clinical features characteristic of each disorder. Diagnostic significance of nonspecific clinical findings is enhanced when considered together. Of the infectious diseases that are associated with FUO, tuberculosis (Especially in extrapulmonary sites) was most common cause (eg. 13.8%) and in malignant aetilogy, lymphoma was the major cause (eg. 11.1%) of fever of unknown origin. Abdominal and or Pelvic abscesses (5.6%) Colorectal carcinoma (5.6%) Drug-induced fever (4.1%) UTI (5.6%) SLE (5.6%) Rheumatoid arthritis (9.7%) Dental abscesses (2.7%) and Osteomyelitis (4.1%) were the others common cause of fever of unknown origin. Conclusion: Fever is a common presenting complaint in hospital admitted patients. Most febrile illnesses either resolve before a diagnosis can be made or develop distinguishing characteristics that lead to a clinical dilemma. Fever of Unknown Origin (FUO) is dynamic in its origin and will be an ongoing challenge to the clinician because of shifting disease epidemiology. In this study infection was predominant aetiology for febrile illness. Proper evaluation, rationale use of drugs and health awareness reduced the burden of Fever of unknown origin. Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 6-13

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“…Although the spleen is frequently involved in patients with non-Hodgkin's lymphoma (NHL), primary splenic diffuse large B-cell lymphoma (PS-DLBCL) without the involvement of any other organ is an extremely rare anatomical subtype of NHL, with an incidence rate of less than 1% of NHLs and less than 2% of all lymphomas [ 1 , 2 ]. While many different criteria have been used to define this primary neoplasm of the spleen, the most appropriate way to define this disorder would be an NHL that is confined to the spleen or involves splenic hilar lymph nodes [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Primary Splenic Diffuse Large B-cell Lymphoma: An Atypical Presentation

Pirzada¹,

Hasnain²,

Mankani³

et al. 2023

Cureus

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Primary splenic diffuse large B-cell lymphoma (PS-DLBCL) is an extremely rare type of non-Hodgkin's lymphoma. It typically presents with abdominal pain and a rapidly enlarging mass, often accompanied by B symptoms. Here, we present a rare presentation of PS-DLBCL in a 54-year-old woman who experienced splenomegaly. A CT scan of her abdomen revealed an enlarged spleen measuring 12 x 15 x 14 cm with a hypodense lesion. Confirmation of diffuse large B-cell lymphoma was obtained through a splenic core biopsy. A subsequent positron emission tomography scan showed a large hypermetabolic and centrally necrotic infiltrative splenic mass without any evidence of pathology in other parts of the body. The patient's condition was classified as stage I PS-DLBCL, and she underwent treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy for four cycles. This case report highlights the unique presentation of diffuse large B-cell lymphoma with exclusive involvement of the spleen and discusses the potential therapeutic role of radiation therapy and R-CHOP without the need for splenectomy.

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Fever of unknown origin revealed to be primary splenic lymphoma: A rare case report with review of the literature

Cited by 9 publications

References 38 publications

The Key Role of Splenectomy in Fever of unknown Origin which Resulted to be B-cell primary Splenic Lymphoma.

The Key Role of Splenectomy in Fever of unknown Origin which Resulted to be B-cell primary Splenic Lymphoma.

Clinico-Pathological Evaluation of Fever More Than Three Weeks : A Cross Sectional Study in A Tertiary Care Hospital

Primary Splenic Diffuse Large B-cell Lymphoma: An Atypical Presentation

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