Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Medicine
Volume 2013, Article ID 153798, 5 pages
http://dx.doi.org/10.1155/2013/153798
Case Report

An Elderly Lady with Fever of Unknown Etiology and Severe Pulmonary Hypertension: Intravascular Lymphoma—An Elusive Diagnosis

1Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Affiliated with Albert Einstein College of Medicine, Bronx, NY 10457, USA
2Department of Internal Medicine, Bronx Lebanon Hospital Center, Affiliated with Albert Einstein College of Medicine, Bronx, NY 10457, USA
3Department of Pathology, Bronx Lebanon Hospital Center, Affiliated with Albert Einstein College of Medicine, Bronx, NY 10457, USA

Received 26 August 2013; Revised 12 October 2013; Accepted 25 November 2013

Academic Editor: Reda E. Girgis

Copyright © 2013 Nupur Sinha et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pulmonary hypertension (PH) associated with malignancy, especially adenocarcinoma, is a well-known entity and is included in group V of the WHO classification. Intravascular lymphoma is a rare type of diffuse large B cell lymphoma, characterized by selective intravascular growth of malignant lymphocytes, aggressive behavior, and often a fatal course. Most of the time, diagnosis is postmortem due to the rarity and the protean manifestations of the disease. We present a rare case of an elderly patient presenting with severe pulmonary hypertension, fever of unknown etiology (FUO), and lymphadenopathy. Extensive evaluation searching for the etiology of her FUO and PH was noncontributory. The diagnosis of intravascular lymphoma was finally reached by the performance of a random abdominal fat pad biopsy and the patient was started on immunochemotherapy. She continues the follow up after 6 cycles of R-CHOP with no further febrile episodes and steady improvement in exercise tolerance.