Abstract Details

Title Neurolymphomatosis: A Rare Presentation of Occult Lymphoma

Topic General Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-005

Objective N/A

Background Neurolymphomatosis is a rare condition characterized by the invasion of peripheral nerves by B-cell non-Hodgkin's lymphoma or acute leukemia. It is seen in <5% of recurrent lymphoma cases and is extremely rare to be associated with a new diagnosis of lymphoma or leukemia. Here, we present a case of neurolymphomatosis in a patient without known malignancy.

Design/Methods A 77-year-old woman with a remote history of immune-mediated left lumbosacral plexopathy with residual left lower extremity weakness presented to the hospital with progressive painless left arm and right leg weakness over several months. Her weakness continued to progress to a more painful neuropathy involving all extremities. Patient underwent extensive workup including brain MRI, cervical/lumbar spine MRI, lumbar puncture, and rheumatologic workup. EMG was consistent with right lumbar and left brachial plexopathy vs multiple asymmetric polyneuropathies. Sural nerve biopsy was negative for evidence of vasculitis, therefore the diagnosis was initially presumed to be an autoimmune etiology. However, the patient was not responsive to prednisone 60mg daily, IV immunoglobulin (IVIG), or plasma exchange. On further investigation, MRI of the brachial plexus demonstrated a 10.4cm mass encasing the left brachial plexus. Needle biopsy was nondiagnostic. An open biopsy was performed, which revealed aggressive B-cell lymphoma. The patient was started on chemotherapy for treatment.

Results N/A

Conclusions New cases of neurolymphomatosis, a rare complication of recurrent B-cell lymphoma or leukemia, are uncommon. Our patient presented with neurolymphomatosis of multiple peripheral nerve roots, including the right lumbar plexus and left brachial plexus, coinciding with a new diagnosis of large B-cell lymphoma. This case highlights the importance of including B-cell lymphoma or leukemia in the differential diagnosis when a patient presents with peripheral nervous system dysfunction, even in the absence of a prior history of lymphoma or leukemia.

Authors/Disclosures
Sarah N. Glisan, DO PRESENTER	Ms. Glisan has nothing to disclose.
Satinderpal Singh, DO (LVHN Division of Neurology)	Dr. Singh has nothing to disclose.
Jay D. Varrato, DO	Dr. Varrato has nothing to disclose.

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