{
  "abstract": "Intravascular lymphoma is often a late consideration in spinal cord lesions, representing an important diagnostic challenge due to its mimicry of other more common inflammatory or infectious conditions of the spinal cord.We present a case of a 58-year-old female who was admitted with progressive lower back pain, urinary incontinence, bilateral motor weakness and severe anasarca. Neuroimaging revealed swelling of the conus medullaris. The patient was severely hypoalbuminaemic with evident third space fluid loss. Serum paraneoplastic, autoimmune and neuroinflammatory screens were negative and CSF was unremarkable with a negative culture. The patient subsequently developed circulatory insufficiency and complete bilateral paraparesis underpinned by a florid multi-system inflammatory illness. Skin biopsy was performed which confirmed a diagnosis of intravascular large B cell lymphoma.Discussion Painful conus myelopathy with a pseudo-inflammatory appearance is well described in the setting of intravascular lymphoma. The mechanism for discrete spinal cord lesions in intravascular lymphoma is due to occlusion of small blood vessels, causing ischaemia, necrosis and inflammation of the affected tissues. Early diagnosis is paramount to initiate prompt treatment and limit evolving spinal cord infarction. Specifically, this case highlights the utility of a skin biopsy in those with atypical spinal cord syndromes.stephanie.williams58@nhs.net",
  "authors": [
    {
      "affiliations": [
        "St George’s University Hospitals NHS Foundation Trust"
      ],
      "name": "Williams Stephanie"
    },
    {
      "affiliations": [
        "St George’s University Hospitals NHS Foundation Trust"
      ],
      "name": "Fletcher Phillip"
    }
  ],
  "title": "71 A conus conundrum",
  "uid": "d3c7a39d-2145-5176-84df-0192c49e6301"
}