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• Vol.55 No.2
• CLINICA NEUROL, 55: 115−118, 2015
• Vol.55 No.2 contents

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)