Multiple Cranial Neuropathies in a Patient With Diffuse Large B-cell Lymphoma: Case Report and Review of Literature

Abstract

Neuropathies can occur in patients with diffuse large B-cell lymphoma (DLBCL) at any stage of the disease as a presenting symptom or during later stages of illness. A wide spectrum of neurological association is known to occur with DLBCL, ranging from cranial nerve palsies to peripheral neuropathies. Evaluation of cranial and peripheral neuropathies in patients with DLBCL requires meticulous clinical, imaging, and electrodiagnostic testing. A 75-year-old right-handed female with a known history of multiple cranial neuropathies and DLBCL presented with acute dysphagia and upper extremity weakness of one-week duration. On evaluation, she was found to have right vagal nerve palsy. Cerebrospinal fluid (CSF) analysis along with flow cytometry testing showed CD19 and CD20 positive B cells, confirming neoplastic infiltration of CSF. We describe the case and review the literature of the association of cranial nerve palsies with DLBCL.

Peripheral nervous system involvement in lymphomas

“…The cranial nerves involvement is rare in the course of lymphomas, and it is seen in only 5% of patients with DLBCL . It might be both the initial presentation of a lymphoma and the site of relapse.…”

“…In the differential diagnosis, infectious comorbidities (eg, VZV) and side effects of therapies (chemotherapy and radiation) should be considered . Clinical presentation may be a mononeuropathy or a multi‐neuropathy, with symptoms consistent with the cranial nerve involved (eg, ptosis, facial palsy, facial hypoesthesia or paresthesia, dysphagia, and visual impairment). Pain may also be present.…”

“…Unilateral or bilateral facial nerve palsy has been reported as rare complication of DLBCL or WM . Vagus nerve involvement has been anecdotally reported in a patient with vocal cord paralysis due to DLBCL …”

“…The cranial nerves involvement is rare in the course of lymphomas, and it is seen in only 5% of patients with DLBCL. 132 It might be both the initial presentation of a lymphoma and the site of relapse. Despite rare, cranial nerves involvement is more frequent in hematological than in solid tumors, and lymphoma should always been considered in the presence of unexplained cranial nerves damage.…”

“…In the differential diagnosis, infectious comorbidities (eg, VZV) and side effects of therapies (chemotherapy and radiation) should be considered. 8,133 Clinical presentation may be a mononeuropathy or a multineuropathy, 132 Lymphoma may also primarily locate in the intraocular structures, in oculomotor muscles, or in ciliary nerves. [138][139][140] Only a few cases of primary trigeminal nerve lymphoma have been reported.…”