Fiebre de origen desconocido como presentación de linfoma intravascular de células grandes B

Intravascular large B-cell lymphoma (IVLBCL) presents diagnostic challenges due to the absence of pathognomonic signs and symptoms, lack of lymphadenopathy, and the presence of nonspecific clinical manifestations such as fever of unknown origin, malaise, and anemia. Recognizing its diverse clinical presentations is essential for early diagnosis and improved patient outcomes. This retrospective study analyzed the presenting symptoms, clinical and laboratory findings, clinical course and treatment strategies in four patients diagnosed with IVLBCL at our institution over the past 15 years. All patients presented with fever of unknown origin, absence of lymphadenopathy, anemia, elevated serum ferritin, markedly increased levels of lactate dehydrogenase and β2-microglobulin, and monocytosis in three of the four cases. Neurological symptoms were also observed in three patients. Positron emission tomography (PET) showed bone marrow uptake in two of the three patients who underwent the scan; however, histologic confirmationof marrow involvement was found in only one case. In two patients, the diagnosis was established via random skin biopsy of clinically normal-appearing skin. Given the presence of fever of unknown origin, random skin biopsy should be considered, as it may facilitate early identification of IVLBCL. Increased awareness of the varied clinical presentations of IVLBCL can lead to earlier diagnosis and, consequently, better outcomes for these patients.