eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2025-11-12 13 11 66 70 10.12691/ajmcr-13-11-1 AJMCR202513111 article Chihiro Maekawa 1 Noriko Tanaka 1 Kouhei Yamada 2 Toshio Hasegawa 3 Youichi Yanagawa yyanaga@juntendo.ac.jp 3 Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University Department of Hematology, Shizuoka Hospital, Juntendo University, Shizuoka, Japan Department of Dermatology, Shizuoka Hospital, Juntendo University, Shizuoka, Japan A 76-year-old male patient presented at a local medical facility with complaints of upper abdominal pain. He was subsequently referred to our hospital for emergency care due to an abdominal aneurysm, as well as leukopenia and thrombocytopenia. Upon arrival, the patient exhibited moderate fever. A physical examination revealed a flat abdomen with tenderness and recoil pain in the upper abdomen. Consequently, a comprehensive blood test revealed bicytopenia, an inflammatory reaction, abnormal glucose tolerance, and hyperlactate dehydrogenase (LDH)emia. A whole body computed tomographic scan revealed an enlarged pancreatic head and abdominal aorta with mural thrombus without significant lymph node enlargement. The patient was administered steroids under the diagnosis of hemophagocytic syndrome, resulting in the resolution of fever, a decline in LDH and CRP levels. On the 19th day, a skin biopsy revealed a diagnosis of intravascular large B-cell lymphoma (IVLBCL). Consequently, the patient underwent repeated chemotherapy. However, the patient developed multiple organ failure and died on day 74. https://pubs.sciepub.com/ajmcr/13/11/1/ajmcr-13-11-1.pdf intravascular large B-cell lymphoma random skin biopsy abdominal pain