• Norihito Kaku, Masafumi Seki, Seiji Doi, Tomayoshi Hayashi, Daisuke Imanishi, Yoshifumi Imamura, Shintaro Kurihara, Taiga Miyazaki, Koichi Izumikawa, Hiroshi Kakeya, Yoshihiro Yamamoto, Katsunori Yanagihara, Takayoshi Tashiro, and Shigeru Kohno.
• The Second Department of Internal Medicine, Nagasaki University Hospital, and Department of Hematology, Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki.
• Intern. Med. 2010 Jan 1; 49 (24): 2697-701.

AbstractA 58-year-old woman was admitted with refractory fever despite receiving broad-spectrum antibiotics. She had hypoxemia, severe anemia, elevated levels of serum lactic dehydrogenase and soluble interleukin-2 receptor, and a positive direct Coombs test, which suggested an underlying autoimmune hemolytic anemia (AIHA). Chest computed tomography (CT) showed no abnormal findings, but she had hypoxia, and her alveolar-arterial oxygen difference (A-aDO2) was increased. A random transbronchial lung biopsy (TBLB) was performed, and pathological analysis showed massive proliferation of tumor cells in the lumina of the small vessels. Intravascular large B-cell lymphoma (IVLBCL) was diagnosed, and her general status improved after chemotherapy.

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