Intravascular large B-cell lymphoma with respiratory failure diagnosed by random skin biopsy: A case report

Intravascular large B-cell lymphoma (IVLBCL) typically involves nonspecific symptoms that complicate diagnosis. This report discusses the case of a 70-year-old man, who presented with dyspnea, fatigue, and weight loss that evolved into severe respiratory failure, diagnosed with IVLBCL via random skin biopsy. The initial improvement in respiratory symptoms was followed by coronavirus disease. Response to steroid therapy and elevated lactate dehydrogenase levels suggested IVLBCL, confirmed by a random skin biopsy. The combination chemotherapy of rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone improved the respiratory condition. This case highlights the diagnostic challenges associated with IVLBCL and the crucial role of random skin biopsy. •IVLBCL is characterized by tumor cells proliferating within small blood vessels.•IVLBCL can be hard to diagnose due to nonspecific imaging findings and symptoms.•This case was eventually diagnosed with IVLBCL through a random skin biopsy.•It's vital to consider IVLBCL with unexplained severe respiratory failure.