{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:45:07Z","timestamp":1792410307779,"version":"4.4.0"},"reference-count":11,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Central nervous system (CNS) involvement associated with Richter transformation (RT) is a rare complication of chronic lymphocytic leukemia (CLL). Neurological manifestations are heterogeneous. To our knowledge, no previous reports have described CNS RT presenting predominantly with psychiatric and behavioral symptoms. We report a clinically suspected case of CNS RT presenting predominantly with progressive psychiatric symptoms in the presence of extensive CNS lesions but without apparent focal neurological deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 71\u2010year\u2010old man with no psychiatric history developed progressive personality change, irritability, emotional lability, behavioral disinhibition, and sleep\u2013wake cycle disturbance. Gadolinium\u2010enhanced fluid\u2010attenuated inversion recovery magnetic resonance imaging demonstrated newly developed multifocal lesions predominantly involving the bilateral temporal lobes. Hematological evaluation established previously unrecognized CLL. Although histopathological confirmation was not obtained, the overall clinical, radiological, and laboratory findings supported CNS involvement associated with clinically suspected RT as the most likely diagnosis. Progressive neuropsychiatric deterioration limited invasive diagnostic procedures and disease\u2010directed treatment. Supportive and palliative management was provided, and the patient died of aspiration pneumonia 114 days after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates that clinically suspected CNS RT may present predominantly with progressive psychiatric and behavioral symptoms in the absence of focal neurological deficits. Severe neuropsychiatric symptoms may themselves impede diagnostic confirmation and disease\u2010directed treatment. When pathological confirmation is not feasible, multidisciplinary discussion and shared decision\u2010making with the patient and family, together with explicit acknowledgment of diagnostic uncertainty and careful balancing of the benefits and burdens of further investigation and treatment, may support patient\u2010centered care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70421","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:10:54Z","timestamp":1792408254000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinically suspected central nervous system Richter transformation presenting with progressive psychiatric symptoms: A case report"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8513-2373","authenticated-orcid":false,"given":"Tetsuro","family":"Ishida","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Neurology Sapporo Royal Hospital Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Sugama","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Department of Medicine Higashi Sapporo Hospital Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.27546"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-024-02492-4"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-025-01446-y"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000012701"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1176\/jnp.9.3.429"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.70623"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.6081"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17142352"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2013.606"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2026.109515"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-026-10364-z"}],"container-title":["Psychiatry and Clinical Neurosciences Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70421","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pcn5.70421","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70421","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:10:55Z","timestamp":1792408255000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pcn5.70421"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":11,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["10.1002\/pcn5.70421"],"URL":"https:\/\/doi.org\/10.1002\/pcn5.70421","archive":["Portico"],"relation":{},"ISSN":["2769-2558","2769-2558"],"issn-type":[{"value":"2769-2558","type":"print"},{"value":"2769-2558","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"2026-08-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70421"}}