Concurrent splenic infarction and pulmonary embolism as the initial presentation of high-grade follicular lymphoma: a case report

Background Follicular lymphoma (FL) is a common indolent non-Hodgkin lymphoma, reports of concurrent splenic infarction and pulmonary embolism as the initial complication are relatively uncommon. We report a case of high-grade follicular lymphoma presenting with pulmonary embolism and splenic infarction as prominent clinical features, aiming to improve the recognition of atypical manifestations of this disease. Case presentation The patient was presented with long-term multiple enlarged lymph nodes throughout the body. Laboratory tests showed elevated D-dimer and β2-microglobulin levels, as well as thrombocytopenia. Imaging studies demonstrated multiple lymphadenopathies, marked splenomegaly with increased metabolic activity, and diffuse bone marrow hypermetabolism. Results The patient underwent lymph node biopsy of the left cervical and right axillary regions, histopathological examination and immunohistochemistry of the lymph node biopsy confirmed the diagnosis of high-grade follicular lymphoma. Bone marrow examination revealed bone marrow infiltration. The patient received R-CDOP regimen chemotherapy, at the time of discharge, the patient’s condition was relatively stable. Conclusion This case suggests that in patients with unexplained splenomegaly complicated by thrombotic events and long-standing lymphadenopathy, a high index of suspicion for underlying follicular lymphoma or other lymphoproliferative disorders should be maintained. Standardized pathological and imaging evaluations are essential to guide precise treatment.