Primary CNS lymphoma presenting as fever of unknown origin

Salih, Salih Bin; Saeed, Abdullah Bin; Alzahrani, Mohsen; Qahtani, Mohammed Al; Haider, Abdulrazzaq; Palker, Vejy

doi:10.1007/s11060-008-9777-0

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…Among the neoplastic causes of FUO, malignant lymphomas are the most common (20). Besides PSL, other rare sites of lymphomas manifesting as FUO, such as intravascular lymphoma (21), primary central nervous lymphoma (22), colonic lymphoma (23) and pituitary lymphoma (24), have also been reported.…”

Section: Discussionmentioning

confidence: 99%

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

Sun

Cheng

Wang

et al. 2016

Molecular and Clinical Oncology

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Abstract. 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). 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. We herein report the case of a 59-year-old male patient who presented with prolonged unexplained fever and was found to have a diffusely enlarged hypermetabolic spleen, as shown on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography examination. Following splenectomy, histopathological examination revealed primary splenic lymphoma (PSL) of B-cell origin. The patient received 6 courses of systemic chemotherapy with rituximab, etoposide, cyclophosphamide, doxorubicin, vincristine and prednisone (R-ECHOP regimen) and responded well to treatment. Thus, in patients with FUO and splenomegaly, the possibility of PSL should be taken into consideration. IntroductionThe term ʻfever of unknown originʼ (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). Several decades later, the criteria of FUO diagnosis have changed and it is currently defined by lack of a definitive diagnosis after appropriate inpatient or outpatient evaluation (2). In view of the patient's clinical circumstances and underlying immune status, FUO was categorized into classic, nosocomial, neutropenic and human immunodeffiency virus (HIV)-associated FUO by Durack and Street in 1991 (3). The etiologies of classic FUO mainly include infections, malignancies, non-infectious inflammatory diseases and miscellaneous causes, while some cases remain undiagnosed (4,5).Primary splenic lymphoma (PSL) is a rare malignant lymphoma with an incidence of ~1% among patients with non-Hodgkin lymphoma (NHL) (6), although the spleen is involved in approximately half of the cases of Hodgkin's disease and one-third of NHLs as part of systemic disease (7,8). Dasgupta et al (9) strictly defined PSL as lymphoma originating in the spleen and limited to the spleen and splenic hilum, without invasion of other sites, with an interval of ≥6 months prior to the appearance of lymphoma elsewhere.We herein present the case of a 59-year-old male patient with diffuse large B-cell PSL, who only exhibited sustained fever, without other remarkable complaints. To investigate the cause of the FUO, fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG-PET/CT) examination was performed and revealed a diffusely enlarged hypermetabolic spleen. Following diagnostic splenectomy, the histopathological diagnosis was diffuse large B-cell primary splenic NHL. Case reportA 59-year-old male patient presented with a history of fe...

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Section: Discussionmentioning

confidence: 99%

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

Sun

Cheng

Wang

et al. 2016

Molecular and Clinical Oncology

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“…Patients with PCNSL may infrequently present with FUO as the initial clinical manifestation [15]. The majority of patients with PCNSL reportedly develop a solitary supratentorial tumor, and the most common sites are the frontal lobe, temporal lobe, parietal lobe, deep nuclei, occipital lobe, cerebellum, or the brain stem.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Lymphomatosis Mimicking Primary Central Nervous System Lymphoma: A Case Report and Literature Review

Oomura¹,

Sakakibara

Suzuki³

et al. 2014

Case Rep Neurol

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We herein report a 75-year-old female patient with intravascular lymphomatosis (IVL) who presented with fever of unknown origin. Examination, including contrast-enhanced CT and ⁶⁷Ga scintigraphy, failed to show any lesions. Her blood levels of lactate dehydrogenase and soluble interleukin-2 receptors were high, suggesting a lymphomatous tumor. A bone marrow puncture was negative, and a random skin biopsy revealed a monoclonal proliferation of naked, large lymphocytes in the vascular space of the subcutaneous tissue, confirming the diagnosis of IVL. MRI, performed 7 weeks after admission, showed a brain mass mimicking primary central nervous system lymphoma. The mass was considered to be a collection of malignant lymphocyte cells invading from the vessels. Without the random skin biopsy, this case may have been misdiagnosed as primary central nervous system lymphoma.

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“…Several investigators have pointed out that rare sites of involvement by intravascular large B-cell lymphoma can be clinically asymptomatic early in the process. Therefore, FDG-PET imaging may prove to be superior in detecting disease sites compared to pelvic CT and MRI, which often appear negative [36,37]. In addition to primary splenic lymphoma, rare sites of involvement such as colonic lymphoma and pituitary lymphoma have been found to cause FUO and have been effectively detected by FDG-PET [38,39].…”

Section: Malignancymentioning

confidence: 99%

FDG-PET imaging to detect and characterize underlying causes of fever of unknown origin: an unavoidable path for the foreseeable future

Al-Zaghal

Raynor

Seraj

et al. 2018

Eur J Nucl Med Mol Imaging

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Primary CNS lymphoma presenting as fever of unknown origin

Cited by 7 publications

References 20 publications

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

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

Intravascular Lymphomatosis Mimicking Primary Central Nervous System Lymphoma: A Case Report and Literature Review

FDG-PET imaging to detect and characterize underlying causes of fever of unknown origin: an unavoidable path for the foreseeable future

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