# A Rare Case of Intravascular Large B-cell Lymphoma Presenting as Leukemic Phase in a Patient With HCV-Related Cirrhosis

## TL;DR

A rare case of aggressive lymphoma presenting as a leukemic phase in a patient with cirrhosis is reported, highlighting diagnostic challenges in such complex cases.

## Contribution

Presentation of a rare case of IVLBCL with a leukemic phase in a cirrhotic patient, emphasizing diagnostic difficulties.

## Key findings

- Intravascular large B-cell lymphoma was confirmed through peripheral smear and flow cytometry.
- The patient's presentation included a leukemic phase, a rare manifestation of IVLBCL.
- Liver dysfunction complicated the diagnosis due to overlapping symptoms with lymphoma.

## Abstract

We report a rare case of a 65-year-old man with decompensated cirrhosis due to alcohol and HCV, who presented with altered mental status, hypotension, and a diffuse rash. Laboratory findings were notable for leukocytosis, severe coagulopathy, and acute kidney injury. Peripheral smear and flow cytometry confirmed intravascular large B-cell lymphoma (IVLBCL), a rare and aggressive subtype of non-Hodgkin lymphoma characterized by intravascular proliferation of malignant lymphocytes. Even more rarely, the patient presented with a leukemic phase, marked by circulating lymphoma cells, a presentation reported in only a few cases worldwide. The diagnostic challenge was further compounded by liver dysfunction, as features of advanced cirrhosis, such as coagulopathy, encephalopathy, and renal injury closely overlapped with lymphoma-related findings. This case underscores the need for a broad differential diagnosis in cirrhotic patients with multiorgan dysfunction and highlights how systemic illness can obscure and delay the recognition of aggressive malignancies.