The patient was treated with six cycles of rituximab-bendamustine, resulting in complete regression of the nasopharyngeal mass and reduction in splenomegaly, with minimal residual lymphadenopathy and good clinical and biological tolerance. This case highlights the importance of considering CLL in the differential diagnosis of nasopharyngeal masses and emphasizes the role of combined imaging, histology, and immunophenotyping in establishing an accurate diagnosis and guiding appropriate management.
Post-treatment positron emission tomography/computed tomography (PET/CT) confirmed complete metabolic remission. This case highlights an exceptionally rare and aggressive presentation of HGBL-NOS with extensive extranodal dissemination involving 11 organs in the absence of lymphadenopathy, underscoring the importance of early integrated diagnostic approaches and prompt initiation of intensive chemotherapy to achieve favorable outcomes.
The therapeutic use of isotonic bicarbonate solution is limited owing to paradoxical intracellular acidosis. Tris-hydroxymethyl aminomethane rapidly corrects intracellular acidosis, restoring hepatic lactate clearance through the Cori cycle.