Ide Shiro, Ohara Shin, Uchida Tomoyuki, Inoue Morihiro, Hua Jian, Hagihara Masao
Department of Hematology, Eiju General Hospital.
Rinsho Ketsueki. 2019;60(4):326-330. doi: 10.11406/rinketsu.60.326.
A 65-year-old male was admitted for bladder and rectal dysfunction with lower-limb sensory disturbance. Although no abnormalities were detected on magnetic resonance imaging of the brain and spinal cord, an elevation in the serum anti-cytomegalovirus (CMV) -IgM level and pneumonia suggest viral meningomyelitis. However, steroid pulse and anti-CMV treatments did not resolve the patients' symptoms. Lung and skin biopsies revealed an invasion of atypical lymphoid cells into small vessels, consistent with intravascular large B-cell lymphoma (IVLBCL). Chemotherapy comprising R-CHOP and intrathecal administration of methotrexate resolved neurological complications quickly, and the patient remains in complete remission after 2 years. Notably, IVLBCL with cauda equina syndrome is highly rare.
一名65岁男性因膀胱和直肠功能障碍伴下肢感觉障碍入院。尽管脑部和脊髓的磁共振成像未发现异常，但血清抗巨细胞病毒（CMV）-IgM水平升高及肺炎提示病毒性脑膜脊髓炎。然而，类固醇冲击治疗和抗CMV治疗未能缓解患者症状。肺和皮肤活检显示非典型淋巴细胞侵入小血管，符合血管内大B细胞淋巴瘤（IVLBCL）。包含R-CHOP方案的化疗及鞘内注射甲氨蝶呤迅速缓解了神经并发症，患者在2年后仍处于完全缓解状态。值得注意的是，伴有马尾综合征的IVLBCL极为罕见。
