抄録
A 71-year-old man with hypertension presented with normal blood pressure without the use of antihypertensive medication in the past 6 months, low-grade fever and nocturnal sweating for 2 weeks, and anorexia for a week. The patient visited a different hospital and although the findings of blood examination suggested malignant lymphoma, computed tomography showed only splenomegaly and random skin biopsy showed no abnormality. Two weeks later the patient was referred to our hospital. Upon admission, physical examination revealed hypotension, tachycardia, and enlarged thyroid gland. Blood examination revealed elevated CRP, LDH, and soluble IL-2 receptor, hypothyroidism, low LH, high prolactin, and low early morning cortisol. CRH/TRH/LHRH loading test and GH releasing protein-2 loading test showed abnormal endocrine disorder of the hypothalamic-pituitary axis. After bone marrow biopsy failed to inform a diagnosis, a second random skin biopsy revealed the presence of CD3-negative and CD20- positive atypical lymphocytes in the blood vessels, which supported a diagnosis of intravascular large B-cell lymphoma (IVLBCL). IVLBCL can present with endocrine disorders of the hypothalamus-pituitary axis and can be diagnosed by repeated random skin biopsy. When a patient presents with unexplained endocrine disorders and IVLBCL is strongly suspected, random skin biopsy should be repeated even if the first biopsy is negative.
