Bilateral Numb Chin Syndrome as the Initial Presentation of Burkitt's Lymphoma/Leukemia: A Report of Two Cases and Review of the Literature

Late recurrence of Burkitt's lymphoma in the jaw: numb chin syndrome as the only symptom

The Numb Chin Syndrome (NCS) is defined as facial and oral numbness restricted to the mental nerve’s distribution involving the lower lip, skin of the chin, or gingiva of the lower anterior teeth. Hypoesthesia can occur unilaterally or bilaterally. Although this syndrome is rare, its importance is related to the fact that it represents the clinical manifestations of malignant diseases. Breast cancer and non-Hodgkin lymphoma are the most common cause of NCS. The patient, a 58-year-old woman, treated for a Burkitt Lymphoma (BL) nine years ago, described a two-week history of change in sensitivity and pain in the chin region, without relief with the use of analgesics. She had no headache, speech disturbance, dysphagia, visual disturbance, or other neurological symptoms. No surgical intervention has been performed recently. The intraoral examination revealed a healthy oral mucosa and a small area adjacent to the right mental nerve region that was uncomfortable to palpation. No changes were found in the bone trabeculae at cone-beam computed tomography. The contrasted magnetic resonance features made it possible to identify a change in the mandibular body extending to the entire right side, coinciding with the patient’s complaint, indicating a probable mandibular medullary invasion. The patient was submitted to a biopsy to rule out a possible recurrence of BL. The microscopic findings were consistent with the diagnosis of BL. The present report described a very unusual presentation of late recurrent BL nine years after the first treatment, which manifested as an NCS.

Neurological Components in Coronavirus Induced Disease: A Review of the Literature Related to SARS, MERS, and COVID-19

Background. COVID-19 has been declared the pandemic of the 21st century, causing more than 45,000 deaths worldwide. The abrupt release of SARS-CoV-2 demonstrated the potential infection, morbidity, and lethality of zoonotic viruses and human-to-human transmission. Fever, cough, and fatigue are reported as the most common symptoms of the disease, including acute respiratory distress syndrome, and also signs of severe illness, such as shock, acute cardiac injury, and renal lesions, are described. Considering the previous works related to human coronavirus and other zoonotic infections, it has been demonstrated that the neuroinvasive propensity is a common characteristic of coronaviruses, especially in SARS-CoV and MERS-CoV. Objective. In the present review, we analyzed the potential neurological components involved in coronavirus infections and detailed the neurological syndromes related to COVID-19. We also examined the mechanism of transmission and CNS pathology related to other viruses with similar structures such as SARS-CoV and MERS-CoV. Methods. A comprehensive search of different original articles and clinical, experimental, and review studies was conducted in MEDLINE/PubMed, Scopus, and Web of Science. We selected 92 articles that have been published in journals or preprints according to the search words and the inclusion and exclusion criteria. Results. COVID-19 patients may experience neurological symptoms such as headache, impaired mental status, confusion, dizziness, nausea and vomiting, anosmia/hyposmia, and dysgeusia/hypogeusia as initial symptoms, with more severe manifestations such as seizures or coma later on. The neurological signs shown are clinical symptoms similar to those reported for SARS-CoV and MERS-CoV. Given that both SARS-CoV and MERS-CoV have similar structures, these viruses may share comparable neurological symptoms and similar progression. Coronaviruses are linked to central nervous system dysfunction, and they are also reported as the probable cause of multiple sclerosis, encephalitis, and meningitis.

Why is That Chin Numb? A Case of Burkitt's Lymphoma Presenting as Numb Chin Syndrome

We report a case of numb chin syndrome (NCS) that preceded the diagnosis of Burkitt's lymphoma (BL) and discuss our findings with emphasis on metastatic malignancies in general and BL in particular causing NCS. A 73-year-old woman presented with worsening right-sided back pain for a week along with right-sided leg weakness and a progressive thigh and perianal numbness. She reported numbness of the chin which started two weeks prior. MRI showed compression of the cauda equina which was highly suggestive of neoplastic process. After debulking mass surgery, biopsy of the tissue from spine revealed BL. The patient received a round of radiotherapy of spine and multiple rounds of chemotherapy. Six months later she had reoccurrence of lymphoma with metastasis and eventually passed away. Presence of NCS in the setting of an underlying malignancy indicates very poor prognosis. In appropriate clinical setting, NCS should trigger work up for an underlying malignancy.

Acute Myeloid Leukemia Presenting with Numb Chin Syndrome: A Case Report and Review of Literature

BACKGROUND Numb chin syndrome is a rare and under diagnosed neuropathy of the inferior alveolar branch of the trigeminal nerve usually causing a lower lip and chin anesthesia or paresthesia. The syndrome is commonly associated with broad-spectrum malignant and non-malignant conditions. CASE REPORT Here we report a case of a 30-year-old male who presented with numb chin syndrome in the form of jaw pain, paresthesia, and hypoesthesia of the mental area as the presenting symptoms of acute of myeloid leukemia with t(8;21) treated with (3+7) protocol (3 days anthracycline+7 days cytarabine). The pain and paresthesia improved but hypothesia persisted. CONCLUSIONS Acute myeloid leukemia is one of the most serious causes of numb chin syndrome which should not be overlooked.

Numb chin syndrome as a presenting symptom of diffuse large B-cell lymphoma with secondary myelofibrosis

Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin's lymphoma that classically presents with rapidly enlarging lymph nodes. We present a 59-year-old man with unusual clinical presentation of numb chin syndrome (NCS) as the first symptom of disease. On evaluation, he was found to have diffuse extranodal skeletal involvement in the form of lytic-sclerotic lesions and minimal lymphadenopathy. Bone marrow biopsy revealed a poorly differentiated tumour with infarction and extensive myelofibrosis. This was subsequently proven to be DLBCL of germinal centre type on immunohistochemical stain. NCS should alarm the clinician to investigate for an advanced underlying malignancy. Extensive myelofibrosis, though described in carcinomas and low grade lymphomas, may also be seen in high grade DLBCL.

Numb Chin Syndrome Leading to a Diagnosis of Salivary Ductal Adenocarcinoma: A Case Report and Review of the Literature

Numb chin syndrome (NCS) refers to a rare sensory neuropathy characterized by numbness of the chin within the distribution of the mental or inferior alveolar nerve. Although NCS is usually caused by a benign process, it should not be underestimated and a thorough diagnostic evaluation for a new or known progressive malignancy should always be performed. Here, we report a case of salivary ductal adenocarcinoma that mimicked a pulpitis and periodontitis in its early presentation accompanied by numbness of chin. The course and diagnosis of this case are discussed, and a brief review of the literature is presented. It is hoped for clinicians to keep the malignant possibility of NCS in mind and take a thorough examination.