The Diagnostic Dilemma of Intravascular Lymphoma

Intravascular large B-cell lymphoma is a rare subtype of diffuse large B-cell lymphoma with an estimated frequency of less than one percent of all the lymphomas. Zuckerman et al [2] called it “the great imitator”, as the disease has variable presentations which may mimic other conditions. We report a 65-year old male who presented with exertional dyspnea and hoarseness for a few days. He developed worsening pancytopenia within one week of the hospital stay, underwent a bone marrow biopsy, and was found to have intravascular diffuse large B cell lymphoma. This case report highlights the atypical presentation of this disease entity, and the need to have a high clinical suspicion in a patient presenting with cytopenia and local organ symptoms without any local organ system pathology during initial investigation.