Lymphoma Presenting as Acute-Onset Dysphagia.

Area of Science:

• Neurology
• Oncology
• Pathology

Background:

• Bell's palsy and vocal cord paralysis can present with severe dysphagia.
• Cranial neuropathies can be challenging to diagnose, with autoimmune and neoplastic causes often overlapping.
• Elevated cerebrospinal fluid protein with normal cell count can be seen in various neurological conditions.

Purpose of the Study:

• To highlight the importance of considering lymphomatous invasion of cranial nerves in cases of relapsing cranial neuropathies.
• To present a case where initial symptoms mimicked an autoimmune disorder but were ultimately caused by lymphoma.

Main Methods:

• Case report of a 61-year-old man with recurrent cranial nerve deficits.
• Diagnostic workup included cerebrospinal fluid analysis and contrast-enhanced MRI.
• Biopsy of a temporal lobe mass confirmed the diagnosis.

Main Results:

• Initial presentation of vocal cord paralysis and dysphagia improved with IVIG for presumed AIDP.
• Subsequent development of hearing loss and vestibular dysfunction.
• MRI revealed eighth cranial nerve enhancement and a temporal lobe mass.
• Biopsy confirmed diffuse large B-cell lymphoma.

Conclusions:

• Diffuse large B-cell lymphoma can present with cranial neuropathies mimicking autoimmune conditions.
• Relapsing cranial neuropathies warrant thorough investigation for underlying malignancy.
• Early diagnosis of lymphomatous cranial nerve involvement is crucial for appropriate management.