• Yimei Zhang and Zhang Jianfeng.
• Department of Neurology, Jinshan Hospital Afliated to Fudan University, Jinshan District, Shanghai, China.
• Medicine (Baltimore). 2023 Jan 20; 102 (3): e32695e32695.

RationalePrimary diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma. It is very rare to find lymphoma in immune -privileged sitesat the same time. We report a case of rapidly progressing DLBCL involving multiple sites in the central nervous system, testis, and orbit.Patient ConcernsA 57-years-old man developed diplopia 1 month ago with severe right periorbital pain and right eyelid ptosis. He developed dysphagia 1 week ago and hoarseness 5 days ago.DiagnosesThe pathology of the left testicle confirmed DLBCL. Immunohistochemical analysis showed that CD20, CD79α, multiple myeloma oncogene-1, BCL2, BCL6 atypical lymphocyte aggregation was positive. Positron emission tomography reveals DLBCL involving the central nervous system, testes, eyes, and other parts of the body.InterventionsWe administered glucocorticoids for pre-chemotherapy treatment, but the patient's condition progressed quickly and was generally poor. The patient's family decided to discharge automatically.OutcomesTwo weeks after he was discharged, we called for a follow-up visit and were told the patient had died.LessonsAtypical clinical symptoms of the disease often confuse the doctor's diagnosis. Adequate examination should be performed before glucocorticoid treatment in order to avoid obscuring the true condition. In some rare diseases, early use of PET-CT may lead to early detection.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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