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[Paraparesis and sensory spinal cord transection caused by an NK-cell lymphoma]
C Seifart1, U Seifart, A Neubauer
1Innere Medizin, Klinik für Pneumologie, Germany.
History And Admission Findings:
A 42-year-old man of Russian origin was admitted because of fever, nocturnal sweating and weight loss. Within 2 days a paraparesis of the legs and a bladder-colon disorder had developed. Neurological examination suggested a spinal cord lesion at T4 and hypaesthesia from T9 downward.
Investigations:
Lymphocytosis was associated with an increase in NK-cells (63% NK-cells; CD16 positive, CD56 negative). Chromosomal findings were: (46 XY ad (1) (P372), ad (3) (P25), DEL (14) Q22 (Q24), RG (5) (RG). Electrophysiological tests indicated a symmetrical prolonged central motor conduction time. Magnetic resonance imaging showed opacification of all nasal sinuses. Histological findings of a biopsy from this site were suspicious of NK-cell lymphoma.
Diagnosis, Treatment And Course:
The neurological symptoms briefly responded to glucocorticoids, but were resistant to chemotherapy. Plasmapheresis, undertaken on the tentative diagnosis of paraneoplastic protein secretion, brought definite improvement in the overall condition. A highly malignant lymphoma was diagnosed 12 months later. It, too, proved to be treatment-refractory.
Conclusion:
A cerebrospinal tap should be routinely performed in patients with NK-cell lymphoma. In view of the poor prognosis, early escalation of treatment should be considered.