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

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.