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Zhou QL, Li ZK, Xu F, Liang XG, Wang XB, Su J, Tang YF. Guillain-Barré syndrome and hemophagocytic syndrome heralding the diagnosis of diffuse large B cell lymphoma: A case report. World J Clin Cases 2022; 10:9502-9509. [PMID: 36159426 PMCID: PMC9477672 DOI: 10.12998/wjcc.v10.i26.9502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/26/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Central nervous system (CNS) lesions and peripheral neuropathy are rare among patients with non-Hodgkin's lymphoma (NHL). Lymphomatous infiltration or local oppression usually accounts for CNS or peripheral nerve lesions. The incidence of peripheral neuropathy was 5%. Guillain-Barré syndrome (GBS) is rare and may occur in less than 0.3% of patients with NHL. Hemophagocytic syndrome (HPS) is a rare complication of NHL. It has been reported that 1% of patients with hematological malignancies develop HPS. Diffuse large B-cell lymphoma (DLBCL) combined with GBS has been reported in 10 cases.
CASE SUMMARY We report the case of a 53-year-old man who was initially hospitalized because of abnormal feelings in the lower limbs and urinary incontinence. He was finally diagnosed with DLBCL combined with GBS and HPS after 16 d, which was earlier than previously reported. Immunoglobulin pulse therapy, dexamethasone, and etoposide were immediately administered. The neurological symptoms did not improve, but cytopenia was relieved. However, GBS-related clinical symptoms were relieved partially after one cycle of rituximab - cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (R-CHOP) chemotherapy and disappeared after six cycles of R-CHOP.
CONCLUSION GBS and HPS heralding the diagnosis of Epstein-Barr virus DLBCL are rare. Herein, we report a rare case of DLBCL combined with GBS and HPS, and share our clinical experience. Traditional therapies may be effective if GBS occurs before lymphoma is diagnosed. Rapid diagnosis and treatment of DLBCL are crucial.
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Affiliation(s)
- Qiao-Lin Zhou
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| | - Zhao-Kun Li
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| | - Fang Xu
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| | - Xiao-Gong Liang
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| | - Xing-Biao Wang
- Department of General Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| | - Jing Su
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| | - Yu-Feng Tang
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
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Al-Attas AA, Aldayel AY, Al Najjar SA, Alkhonezan SM. Guillain-Barré Syndrome Heralding the Diagnosis of Hodgkin Lymphoma: A Case Report. Case Rep Neurol 2020; 12:365-372. [PMID: 33250750 PMCID: PMC7670385 DOI: 10.1159/000509681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023] Open
Abstract
Lymphoma is a prevalent type of lymphoid tissue malignancy that is seldom associated with Guillain-Barré syndrome (GBS). In the majority of instances, both Hodgkin’s and non-Hodgkin’s lymphoma are not proceeded by GBS. Here, we report on a case of a young patient with a manifestation and investigation suggestive of GBS, signaling an unconfirmed diagnosis of Hodgkin’s lymphoma. A cerebrospinal fluid test revealed an albuminocytological dissociation with a noteworthy rise in protein (2.32 g/L). The patient was initiated on intravenous immunoglobulin (IVIG) treatment and then showed dramatic improvement after the third dose of IVIG. His constitutional presentation alongside high inflammatory labs prompted further investigation. An enhanced pan-computed tomography scan showed multiple enlarged mediastinal and hilar lymph nodes that were confirmed as Hodgkin’s lymphoma after biopsy. Brentuximab was initiated immediately after IVIG therapy. This case highlights consideration of Hodgkin’s lymphoma as a differential diagnosis under the auspices of GBS.
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Affiliation(s)
- Alawi Aqel Al-Attas
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Yousef Aldayel
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- *Abdulrahman Yousef Aldayel, Department of Neurology, Prince Sultan Military Medical City (PSMMC), Makkah Al Mukarramah Road, As Sulimaniyah, PO Box 7897, Riyadh (Saudi Arabia),
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Al IO, Koç B, Bayram C, Paslı EU, Yıldız EP, Ayçiçek A, Çalışkan M, Özdemir GN. Variant Guillain-Barré syndrome in a patient with Hodgkin lymphoma: AMSAN. Turk Arch Pediatr 2018; 53:263-266. [PMID: 30872931 DOI: 10.5152/turkpediatriars.2018.4763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/13/2017] [Indexed: 12/11/2022]
Abstract
Lymphomas are solid tumors characterized by the malignant proliferation of lymphoid cells. Neurologic signs encountered in patients with Hodgkin's lymphoma can be due to the direct spread of tumor to the nervous system, secondary to chemotherapy or radiation, secondary to tumor mass compression, infectious causes and paraneoplastic syndromes. Paraneoplastic neurologic syndromes are rarely encountered in patients with Hodgkin's lymphoma and non-Hodgkin's lymphoma. Except for paraneoplastic cerebellar degeneration in Hodgkin's lymphoma and dermato/polymyositis in both Hodgkin's lymphoma and non-Hodgkin's lymphoma, other paraneoplastic syndromes are uncommon and have only been reported as isolated case reports or short series. Here, we present a patient with Hodgkin's lymphoma with symptoms of bilateral lower extremity weakness and loss of sensation before the start of therapy, who was eventually diagnosed as having motor and sensory axonal neuropathy.
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Affiliation(s)
- Işık Odaman Al
- Pediatric Hematology and Oncology Clinic, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Başak Koç
- Pediatric Hematology and Oncology Clinic, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Cengiz Bayram
- Pediatric Hematology and Oncology Clinic, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Ezgi Uysalol Paslı
- Pediatric Hematology and Oncology Clinic, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Edibe Pembegül Yıldız
- Department of Pediatrics, Division of Pediatric Neurology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Ali Ayçiçek
- Pediatric Hematology and Oncology Clinic, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Mine Çalışkan
- Department of Pediatrics, Division of Pediatric Neurology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Gül Nihal Özdemir
- Pediatric Hematology and Oncology Clinic, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
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Stübgen JP. Lymphoma-associated dysimmune polyneuropathies. J Neurol Sci 2015; 355:25-36. [PMID: 26070654 DOI: 10.1016/j.jns.2015.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/05/2015] [Accepted: 06/01/2015] [Indexed: 12/24/2022]
Abstract
Lymphoma consists of a variety of malignancies of lymphocyte origin. A spectrum of clinical peripheral neuropathy syndromes with different disease mechanisms occurs in about 5% of lymphoma patients. There exists a complex inter-relationship between lymphoproliferative malignancies and autoimmunity. An imbalance in the regulation of the immune system presumably underlies various immune-mediated neuropathies in patients with lymphoma. This article reviews lymphoma and more-or-less well-defined dysimmune neuropathy subgroups that are caused by humoral and/or cell-mediated immune disease mechanisms directed against known or undetermined peripheral nerve antigens.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY 10065-4885, USA.
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Taguchi S, Nakamura T, Yamada T, Takamido H, Doyu M, Takahashi A. [Autonomic neuropathy as the first presentation of T-cell malignant lymphoma--a case report]. Rinsho Shinkeigaku 2015; 55:29-32. [PMID: 25672862 DOI: 10.5692/clinicalneurol.55.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 61-year-old man noted flu-like symptoms. Not long afterwards, he felt constipation, nausea, and blackout when standing or sitting. His blood pressure was 110/70 mmHg in the supine position. On sitting blood pressure dropped to 73/34 mmHg. Heart rate increased from 65 to 78 beats per minutes. He did not have fever, edema, or skin rash. The remainder of the general medical examination was normal. A neurological examination revealed normal higher mental, and sensori-motor functions. The blood test revealed leukocytosis 7,320/μl, LD 1,426 IU/l, IL-2R 921 U/ml, and CRP 11.5 mg/dl. A whole body CT scan and cranial MR imaging showed no significant change. Thoracic spine MR imaging revealed multiple T1 low signal small foci in part of the vertebral body suggesting bone metastasis of the tumor. The heart/mediastinum ratio of (123)I-meta-iodobenzylguanidine scintigraphy early imaging was 2.42. The nerve conduction study and electrocardiogram coefficient of variation of R-R intervals showed no abnormalities. Two months after the onset of symptoms, he was found to have glove-and-stocking-form muscle weakness and sensory impairment. The nerve conduction study performed four months after the onset revealed a decreased conduction velocity and conduction block suggesting demyelinated nerve. His neurological manifestations progressed subacutely, despite high-dose intravenous immunoglobulin therapy. Five months after the onset, a histopathological diagnosis of T-cell malignant lymphoma was made on a skin biopsy specimen from the facial rash. To summarise, the present case was a rare example of paraneoplastic autonomic neuropathy as the initial clinical feature in association with T-cell malignant lymphoma.
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Affiliation(s)
- Soutarou Taguchi
- Department of Neurology, Tokai Central Hospital; Aichi Medical University
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Hughes CL, Yorio JT, Kovitz C, Oki Y. Treatment decisions in a man with Hodgkin lymphoma and Guillian-Barré syndrome: a case report. J Med Case Rep 2014; 8:455. [PMID: 25528252 PMCID: PMC4307131 DOI: 10.1186/1752-1947-8-455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/18/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction Guillain-Barre syndrome, or acute inflammatory demyelinating polyneuropathy, has been described in the presence of malignancies such as lymphoma. Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy causes paresthesias and weakness, which can make the treatment of lymphoma with chemotherapy challenging. Given the rarity of this co-presentation it is not known if the effects of Guillain-Barre syndrome should be considered when selecting a treatment regimen for Hodgkin lymphoma. To the best of our knowledge, the impact of these treatment modifications has not been previously reported. Case presentation We report the case of a 37-year-old Caucasian man with a diagnosis of stage IIB classical Hodgkin lymphoma with concomitant Guillain-Barre syndrome. Our patient originally presented with an enlarged cervical lymph node and quickly developed distal paresthesia and progressive weakness of all four extremities. He was diagnosed with Hodgkin’s lymphoma and initiated on treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine. Doses of bleomycin and vinblastine were held or dose-reduced throughout his initial treatment course due to underlying neuropathy and dyspnea. He continued to have persistent disease after five cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and went on to receive salvage treatments including more chemotherapy, radiation, autologous stem cell transplant and is currently preparing for an allogeneic stem cell transplant. Conclusions Paraneoplastic syndromes such as Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy can make the treatment of patients with Hodgkin lymphoma more challenging and can interfere with delivering full-dose chemotherapy. Further case series are needed to evaluate the effect that paraneoplastic syndromes, or adjustments made in therapy due to these syndromes, negatively affect the prognosis of patients with Hodgkin lymphoma.
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Affiliation(s)
- Caren L Hughes
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Ma YY, Zhang L, Zhang DAL, Liu WS. Guillain-Barré syndrome and severe infection following chemotherapy for peripheral T-cell lymphoma: A case report. Oncol Lett 2014; 8:2695-2698. [PMID: 25360176 PMCID: PMC4214403 DOI: 10.3892/ol.2014.2541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 08/28/2014] [Indexed: 02/02/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare complication of malignant lymphoma. The current study describes a case of GBS in a patient with peripheral T-cell lymphoma not otherwise specified (PTCL-NOS). A 47-year-old male was admitted to the First Affiliated Hospital of Zhengzhou University (Zhengzhou, China) with systemic multiple subcutaneous nodules and was diagnosed with stage IV high-grade PTCL-NOS (according to the Revised European American Lymphoma Classification). During chemotherapy, severe infection and progressive flaccid quadriparesis appeared, which eventually developed to respiratory muscles paralysis. The clinical course and neurological examination were consistent with GBS. Following mechanical ventilation and intravenous immunoglobulin administration, the neurological symptoms were in remission after one month. Three months later, the patient achieved complete remission without any treatment during this period. We hypothesized that immune reconstruction may have a significant role in this phenomenon.
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Affiliation(s)
- Yang-Yang Ma
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - DA-Liang Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Wen-Shuo Liu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
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Jiménez Caballero P. Paraneoplastic chorea caused by anti-CRMP5 antibodies associated with small-cell lung cancer. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Jiménez Caballero PE. Corea paraneoplásica por anticuerpos anti-CRMP5 asociada a cáncer microcítico de pulmón. Neurologia 2014; 29:446-7. [DOI: 10.1016/j.nrl.2013.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022] Open
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Navani V, Webster D, Williams SK, Agranoff D. Guillain-Barre syndrome as a paraneoplastic manifestation of disseminated squamous cell carcinoma. BMJ Case Rep 2013; 2013:bcr-2013-009700. [PMID: 23729714 DOI: 10.1136/bcr-2013-009700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We describe a 65-year-old woman who developed ascending, symmetrical paraesthesia and weakness. This was on a background of metastatic disseminated squamous cell carcinoma, with a likely recurrent mandibular primary. Serum testing for antiganglioside antibodies was strongly positive. Despite a 5-day course of intravenous immunoglobulin, the patient passed away on day 34 of admission. This is the first case, to our knowledge, of Guillain-Barré syndrome in association with squamous cell carcimoma.
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Affiliation(s)
- Vishal Navani
- Department of Infectious Diseases, Brighton and Sussex University Hospitals, Brighton, UK.
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