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Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review
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[Cauda equina syndrome as the first presentation of intravascular large B-cell lymphoma: a lung biopsy case]

Shiro Ide1, Shin Ohara1, Tomoyuki Uchida1

  • 1Department of Hematology, Eiju General Hospital.

[Rinsho Ketsueki] the Japanese Journal of Clinical Hematology
|May 10, 2019
PubMed

Insights

Intravascular large B-cell lymphoma (IVLBCL) can mimic viral meningomyelitis. Prompt diagnosis and chemotherapy, including R-CHOP, led to complete remission in a rare case of IVLBCL presenting with cauda equina syndrome.

Area of Science:

  • Neurology
  • Oncology
  • Infectious Diseases

Background:

  • Intravascular large B-cell lymphoma (IVLBCL) is a rare non-Hodgkin lymphoma characterized by proliferation of malignant lymphocytes within blood vessels.
  • Neurological symptoms can be the initial presentation of IVLBCL, often mimicking other conditions.
  • Cauda equina syndrome is an uncommon but severe manifestation of neurological involvement.

Observation:

  • A 65-year-old male presented with bladder/rectal dysfunction and lower-limb sensory disturbance.
  • Initial investigations, including MRI, suggested viral meningomyelitis, but treatment was ineffective.
  • Lung and skin biopsies confirmed intravascular large B-cell lymphoma.

Findings:

  • The patient's neurological symptoms resolved rapidly following chemotherapy with R-CHOP and intrathecal methotrexate.
  • Complete remission was maintained for 2 years post-treatment.
  • This case highlights the diagnostic challenge of IVLBCL presenting as cauda equina syndrome.

Implications:

  • Early recognition of IVLBCL is crucial for timely and effective treatment, even with atypical presentations.
  • Chemotherapy regimens like R-CHOP are effective in managing IVLBCL with neurological complications.
  • This case underscores the importance of considering hematological malignancies in the differential diagnosis of unexplained neurological deficits.

Keywords:
Cauda equina syndromeIntravascular large B-cell lymphomaLung biopsyRandom skin biopsy

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