ArticleFrontiers in medicine2026
Beyond infection-a ferritin-LDH-IL-10 triad to unmask intravascular lymphoma in fever of unknown origin: a case report and literature review.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To highlight the diagnostic value of the ferritin-LDH-IL-10 triad and image-guided targeted biopsy in intravascular large B-cell lymphoma (IVLBCL) presenting as fever of unknown origin (FUO), with a review of relevant literature. Methods: We present a case of a 60-year-old woman with a 10-month history of cough, progressive fever, and weight loss. We retrospectively analyzed her clinical course, laboratory profile, imaging findings, and histopathological results, and reviewed the relevant literature on IVLBCL diagnosis. Results: Extensive initial investigations including multiple biopsies (bone marrow, colon, skin) and imaging were nondiagnostic. Persistent extreme hyperferritinemia (peak >15,000 ng/mL), markedly elevated LDH (735 U/L), and strikingly high IL-10 (>600 pg./mL) formed a diagnostic triad raising suspicion for IVLBCL. Re-review of PET-CT identified a subtle pulmonary FDG-avid focus (SUVmax 3.0), guiding video-assisted thoracoscopic wedge resection. Histopathology confirmed IVLBCL with CD20 + tumor cells within vascular lumina. The patient subsequently met criteria for secondary hemophagocytic lymphohistiocytosis. R-CHOP immunochemotherapy achieved rapid symptom resolution and complete metabolic response on follow-up PET-CT. Conclusion: The triad of extreme hyperferritinemia, elevated LDH, and markedly increased IL-10 may serve as a useful diagnostic clue to raise suspicion for IVLBCL in FUO patients, though its interpretation is confounded by secondary HLH and requires prospective validation. When random biopsies fail, multidisciplinary re-evaluation of PET-CT to identify subtle targets for image-guided biopsy is essential for definitive diagnosis. Early recognition of this triad and adoption of a hypothesis-driven biopsy strategy can significantly improve diagnostic outcomes in this elusive lymphoma.
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