Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of acute progressive myelopathy due to intravascular large B cell lymphoma diagnosed with only random skin biopsy

Hidekazu Yamazaki, M.D.1), Keisuke Imai, M.D.1), Masashi Hamanaka, M.D.1), Takehiro Yamada, M.D.1), Kazuma Tsuto, M.D.1), Atsushi Yamamoto, M.D.1) and Yasuhiko Tsutumi, M.D., P.D.2)

1)Department of Neurology and Stroke Treatment, Kyoto First Red Cross Hospital
2)Department of Hematology, Kyoto First Red Cross Hospital

A 64-year old woman was admitted to our hospital with subacute onset paraparesis and sensory disturbance at a level below Th10. Spinal MRI showed a T2 weighted high-signal intensity lesion at a level from Th5 to Th12, and an abdominal CT showed a mass in the left kidney. Her paraparesis deteriorated rapidly, and administration of high dose methyl prednisolone followed by oral steroid therapy was started before obtaining of a definitive diagnosis. However her symptoms did not improve after the beginning of treatment. At the same time, a bone marrow puncture, and biopsies from kidney and spinal cord were performed. These biopsies demonstrated no clues, diagnostically. Therefore a random skin biopsy was performed at the five sites on the 17th day after the steroid dosage end. From this, pathological evidence of intravascular large B cell lymphoma (IVLBCL) was shown. For rapid diagnosis of acute myelopathy with mass lesion of another organ due to IVLBCL, a biopsy is taken not only from spinal cord or mass lesions, but is also taken of multiple sites in skin randomly. This must be performed without a delay before a sudden deterioration of neurologic symptoms can occur from ischemic events not responsive to steroid therapy.
Full Text of this Article in Japanese PDF (648K)

(CLINICA NEUROL, 55: 115|118, 2015)
key words: acute myelopathy, intravascular large B cell lymphoma, random skin biopsy, spinal biopsy, steroid therapy

(Received: 29-Mar-14)