Hyperventilation as the initial manifestation of lymphomatous meningitis

We present the case of a 57 year old man who developed a B-cell lymphoma which involved his lymph nodes, liver, spleen, bone marrow, and peripheral blood. Shortly after attaining a complete remission with chemotherapy, the patient developed profound hyperventilation with no apparent cardiac or pulmonary cause. After one month, the patient developed a 7th nerve palsy and a subsequent work-up demonstrated that he had lymphomatous meningitis. The hyperventilation resolved completely with intrathecal chemotherapy, although the patient eventually died of widely disseminated lymphoma.