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Diffuse large B-cell lymphoma recurrence presenting as multiple, progressive cranial neuropathies
Abby R Goron1, Stephen Devlin1, Stacy Schwartz2
1University of Maryland School of Medicine, Baltimore, Maryland, USA.
BMJ Case Reports
|July 22, 2019
Summary
This case highlights lymphoma recurrence affecting cranial nerves, causing dysphagia and facial palsy. Prompt diagnosis via cerebrospinal fluid analysis is crucial for effective treatment.
Area of Science:
- Neuro-oncology
- Hematology
- Medical imaging
Background:
- Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma.
- Leptomeningeal disease (LMD) is a rare but serious complication of lymphoma.
- Patients in remission require vigilant monitoring for recurrence.
Observation:
- A 58-year-old man with a history of rheumatoid arthritis and DLBCL presented with acute dysphagia.
- Dysphagia was initially attributed to vagus nerve palsy, followed by facial and vestibulocochlear nerve palsies.
- Imaging revealed pathological enhancement of bilateral seventh and eighth cranial nerves.
Findings:
- Cerebrospinal fluid analysis and flow cytometry confirmed leptomeningeal recurrence of lymphoma.
- Atypical monotypic CD19-positive B cells were identified in the cerebrospinal fluid.
- The findings indicated spread of lymphoma to the central nervous system.
Implications:
- This case underscores the importance of considering LMD in patients with lymphoma presenting with neurological deficits.
- Early detection through cerebrospinal fluid analysis is critical for timely intervention.
- Prompt treatment can potentially improve outcomes in patients with relapsed leptomeningeal lymphoma.
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