Curious case of acute encephalopathy in a 64-yearold male

Abstract

A 64-year-old male presents with acute encephalopathy and upon further evaluation, he was found to have lymphadenopathy in the neck and parotid region. Subsequent lumbar puncture (LP) revealed the presence of blast cells in the CSF concerning for leukemic meningitis. A lymph node biopsy was consistent with CD5 positive DLBCL. He was started on chemotherapy with Hyper-CVAD and intrathecal methotrexate, improving his clinical condition but he was lost to follow up. Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL). Diagnosis is based on symptoms and excisional lymph node biopsy with immunotyping. It is extremely important to have a lymph node biopsy if suspicious for lymphoma because of its aggressive nature. Indicators for such include CD5 positivity and extranodal involvement. The risk factors for CNS involvement in DLBCL include high International Prognostic Index (IPI) score, bone marrow involvement, and extranodal involvement such as bone, lung and testis. The purpose of the report is to emphasize the importance of ruling out lymphoma when diffuse lymphadenopathy is present in the setting of encephalopathy; the potential of aggressive behavior of this disease including involvement of the CNS; and discussing the overall social determinants of health for this patient resulting in delayed diagnosis and lack of an optimal treatment plan to be carried out.