Abstract
A 66-year-old female presented to the hospital for evaluation of multiple strokes over a three-month period. The patient underwent extensive testing to evaluate for autoimmune vasculitis and other hypercoagulable entities that were negative. Bone marrow and lymph node biopsies showed no evidence of lymphoma. An excisional muscle biopsy was then performed, which demonstrated occasional small blood vessels containing atypical CD20+ lymphoid cells, and a diagnosis of intravascular large B-cell lymphoma (IVLBCL) was rendered. The patient underwent systemic chemotherapy along with CNS-directed therapy, followed by a consolidative autologous stem cell transplant. Here, we will discuss an unusual case of IVLBCL, some of the complications that can arise when diagnosis is delayed, and some of the key principles of diagnostic workup and management.