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Abstract Details

Unilateral Painful Plexopathy: Early Diagnosis of Primary Neurolymphomatosis Leading to Remarkable Recovery
Neuro-oncology
P8 - Poster Session 8 (11:45 AM-12:45 PM)
6-005

To demonstrate that early diagnosis and prompt treatment of primary neurolymphomatosis can achieve rapid neurological recovery even in elderly patients, contrasting with the typically poor prognosis reported in the literature.
Primary neurolymphomatosis has poor prognosis with 55% mortality and median survival of 28 months. Diagnostic delays are common due to clinical mimicry of inflammatory conditions, particularly chronic inflammatory demyelinating polyneuropathy. The potential for neurological recovery with early intervention remains underexplored, especially in elderly patients.
We present a 71-year-old man with right upper limb weakness beginning one year prior and progressive pain emerging two months before presentation. Evaluation included neurological examination, laboratory studies, cerebrospinal fluid analysis, brachial plexus MRI, nerve conduction studies, gallium scintigraphy, and FDG-PET. PET-guided lymph node biopsy confirmed diagnosis.
Examination revealed mild atrophy and weakness in right upper extremity with globally decreased reflexes. Laboratory studies showed modest inflammatory markers with normal CSF. MRI demonstrated right brachial plexus enlargement with C5 nerve root enhancement. Nerve conduction studies revealed conduction block in the right axillary nerve. Chronic inflammatory demyelinating polyneuropathy was considered, but strictly unilateral distribution, prominent pain, and poor immunotherapy response were atypical. Steroid pulse therapy provided transient minimal relief with rapid rebound; intravenous immunoglobulin showed no response. Gallium scintigraphy was negative, but FDG-PET revealed hypermetabolic activity in the right brachial plexus and multiple lymph nodes. PET-guided biopsy confirmed diffuse large B-cell lymphoma. After one cycle of R-CHOP with methotrexate, the patient demonstrated significant improvement with pain resolution and conduction block improvement.
Early diagnosis and prompt treatment of primary neurolymphomatosis can achieve rapid neurological improvement in elderly patients. Early intervention may lead to better outcomes than traditionally poor prognosis suggests. Unilateral pain-predominant plexopathy with poor immunosuppressive therapy response should prompt immediate oncological investigation. Timely diagnosis and treatment are critical for optimizing neurological recovery.
Authors/Disclosures
Shota Fukaura, MD
PRESENTER 		Dr. Fukaura has nothing to disclose.
Kentaro Hori, MD Dr. Hori has nothing to disclose.
Junji Tokushige, MD, PhD Dr. Tokushige has nothing to disclose.
shingo kawakami, Sr., PhD Dr. kawakami has nothing to disclose.
Suzuki Shigeaki, MD, PhD Dr. Shigeaki has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for argenx. The institution of Dr. Shigeaki has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Shigeaki has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for alexion. Dr. Shigeaki has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for argenx. Dr. Shigeaki has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. Dr. Shigeaki has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for alexion.