Disclosures: Nevin Vijayaraghavan, DO: No financial relationships or conflicts of interest

Case Diagnosis: Chronic low back pain as an atypical presentation of Diffuse B-Cell Lymphoma.

Case Description: 58-year-old Spanish speaking male presented for 8-month history of chronic low back pain. He worked for a maintenance company that required heavy lifting but denied any injuries. Symptoms were worse with standing, bending, and lifting. Pain radiated to the bilateral hips with associated numbness over the bilateral anterior thighs. He denied fevers, chills, bowel/bladder incontinence, urinary retention, or saddle anesthesia. He had multiple visits to the emergency department over the previous 4 months. Lumbar radiographs 2 months prior demonstrated an age-indeterminate L2 compression fracture. Physical examination illustrated full strength in the bilateral lower extremities, normal reflexes, tenderness to palpation over the lumbar paraspinal muscles, mildly diminished sensation over bilateral thighs, and positive Straight Leg Raise and Kemp’s test bilaterally.

Setting: Outpatient spine center within tertiary care system.Assessment/

Results: Magnetic resonance imaging (MRI) of lumbar spine illustrated abnormal signal of the L2-L3 vertebral bodies with associated subligamentous, epidural, and paravertebral enhancement suspicious for atypical spondylodiscitis with associated phlegmon. Epidural phlegmon resulted in severe canal stenosis from L1-L2 levels with compression of the cauda equina nerve roots. He underwent L2 laminectomy with pathology illustrating abnormal B-cell predominant lymphoid infiltrate, suspicious for B-cell lymphoma. Positron emission tomography (PET) illustrated lobulated hypermetabolic hypodensity in the spleen. Splenic biopsy pathology confirmed diffuse large B cell lymphoma. He was subsequently started on chemotherapy.

Discussion: Low back pain can be a rare presentation of diffuse B-cell lymphoma. It is imperative to expedite the workup for underlying malignancy as an etiology in an effort to obtain tissue diagnosis and initiate appropriate chemotherapy.

Conclusion: Chronic low back pain is a common musculoskeletal complaint, thus it is important to include malignancy as a differential diagnosis that may require further workup, especially in the presence of age-indeterminate compression fracture and failed conservative treatments.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/chronic-low-back-pain-as-an-atypical-presentation-of-diffuse-b-cell-lymphoma-a-case-report/