XXXX Presenting as Skin Lesions and Subacute Encephalopathy.

@entity1 @entity1667 @entity2656 @entity2003 @entity66 @entity706 @entity4812 @entity772 @entity5642 @entity880 @entity10 @entity1851
@entity5642 is a @entity66 ; it is a rare subtype of @entity4812 characterized by the presence of @entity706 cells in the lumina of small vessels. A 49-year-old Caucasian @entity1 was admitted to the Department of Internal Medicine for fatigue, night sweats, loss of weight, and multiple nodules in the forearms. Three months ago the @entity1 's family noticed problems with her cognitive function, she displayed difficulties with common daily tasks. The neurological examination revealed bradypsychia. Laboratory data showed modestly high levels of @entity880 dehydrogenase, and @entity1851 . The day after admission, the @entity1 had @entity10 which raised in intensity; his mental status deteriorated, she was disoriented to time and place. She presented @entity2003 . The CSF examination revealed a hemorrhagic aspect, elements 30/mm3, cytology: lymphocytes 90%, numerous erythrocytes, proteinorachia 96 mg/dL, glycorrachia 60 mg/dL. Intravenous @entity1667 (0.5 g two times a day) and @entity2656 20% 1g/kgw/day were administered for five days without response. She became @entity772 and she died six days after hospitalization. The post-mortem macroscopical brain examination showed a swallen brain, with diffuse hemorrhagic areas in the supratentorial subcortical regions. Microscopical examination showed capillaries, venules, and many arterioles distended by large malignant cells suggesting malignant lymphocytes which were intraluminal. Every organ was involved, except for bone marrow and lymph nodes. Immunohistochemical studies showed intensive staining for B cells. and negative staining for factor VIII related antigen, a specific endothelial cell marker. @entity5642 was the post-mortem diagnostic. It represents a difficult diagnostic challenge which involves laboratory, imagistic and immunohistochemical investigations.
