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Published on: March 7, 2017
Diffuse large B-cell lymphoma presenting with central pontine myelinolysis: a case report
Eri Kawata1, Reiko Isa2, Junko Yamaguchi3
1Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto, 602-8026, Japan. kawatae@kyoto2.jrc.or.jp.
Insights
Central pontine myelinolysis, a rare complication of diffuse large B-cell lymphoma, can occur at disease onset. Prompt treatment led to complete remission and recovery without neurological deficits.
Area of Science:
- Neurology
- Hematology
- Oncology
Background:
- Central pontine myelinolysis (CPM) is typically linked to rapid correction of hyponatremia or severe electrolyte imbalances.
- Hematological malignancies, particularly diffuse large B-cell lymphoma (DLBCL), are rarely associated with CPM, especially at initial presentation.
Observation:
- A 78-year-old woman with persistent fever and edema presented with neurological findings consistent with CPM on MRI.
- She was diagnosed with diffuse large B-cell lymphoma (DLBCL) with disseminated intravascular coagulation and severe hypoalbuminemia.
Findings:
- Brain MRI revealed a lesion in the central pons, indicative of CPM.
- Bone marrow examination confirmed DLBCL. The patient received methylprednisolone and chemotherapy (rituximab with modified THP-COP), achieving complete remission.
Implications:
- This case underscores the importance of considering CPM in patients with hematological malignancies, even at disease onset.
- Early recognition and prompt treatment of both CPM and the underlying malignancy are crucial for patient outcomes.
Introduction:
The most common cause of central pontine myelinolysis is an overly rapid correction of hyponatremia, although it can also occur in patients with any condition leading to nutritional or electrolyte stress. We report a case of diffuse large B-cell lymphoma with central pontine myelinolysis developing at the onset of disease. To the best of our knowledge, hematological malignancies presenting with central pontine myelinolysis have been rarely reported, especially in previously untreated patients, as in our case report.
Case Presentation:
A 78-year-old Japanese woman presented to a neighborhood clinic with persistent high fever, edema, and general weakness. Despite the absence of specific neurological findings, brain magnetic resonance imaging showed an abnormal lesion in the central pons area of her brain (hyperintense on T2-weighted and hypointense on T1-weighted sequences), compatible with central pontine myelinolysis. She was admitted to our emergency department in a state of shock one month later. The results of her blood tests showed greatly elevated C-reactive protein and lactate dehydrogenase levels. She had severe hypoalbuminemia and mild hyponatremia, and showed signs of disseminated intravascular coagulation. Mild bilateral pleural effusion, prominent subcutaneous edema, and splenomegaly were detected on her systemic computed tomography scan. Her body fluid cultures did not show signs of infection and her spinal aspiration did not show pleocytosis or abnormal cells. A diagnosis of diffuse large B-cell lymphoma was made based on the results of her bone marrow examination. As she was critically ill before the diagnosis was made, she was treated with methylprednisolone pulse therapy, followed by systemic chemotherapy (rituximab with modified THP-COP regimen, including cyclophosphamide, pirarubicin, vindesine, and prednisolone), which resulted in complete remission and recovery without any neurological defects, and resolution of her abnormal findings on magnetic resonance imaging.
Conclusions:
Central pontine myelinolysis is a serious condition that may result in neuropathological sequelae and mortality, and clinicians should be aware of its potential presence in patients with malignancies.
