DIFFUSE LARGE B-CELL LYMPHOMA PRESENTING WITH DIABETES INSIPIDUS

A RARE CASE WITH CHALLENGES IN DIAGNOSIS AND MANAGEMENT

Abstract

CASE
Diffuse large B-cell lymphoma that initially presents as a hypothalamic-pituitary axis disorder is rare. A 55-yearold female presented to a community hospital with hyponatremia. Morning cortisol level was 5.34 mcg/dL hence, she was prescribed prednisolone. Her level of consciousness subsequently declined prompting referral to our hospital. She was diagnosed to have central diabetes insipidus and hypothyroidism. Her brain MRI showed a contrast-enhancing lesion with restricted diffusion involving the optic tracts, hypothalamus, internal capsules, and midbrain. Vasogenic edema was also noted. Other lesions were seen at the parietal, subcortical white matter, and periventricular region, suggestive of lymphoma. A whole-body CT scan and bone marrow biopsy did not show extracranial involvement. Stereotactic brain biopsy demonstrated diffuse large B-cell lymphoma. The patient eventually completed a course of cranial radiotherapy. Her neurologic condition eventually improved. Three months after the diagnosis, while waiting for chemotherapy, she developed liver failure and septicemia. Abdominal CT showed possible liver metastases.