Variant Guillain-Barré Syndrome in a Patient with Non-Hodgkin’s Lymphoma

Abstract

We report a 72-year-old female patient with diffuse large B cell non-Hodgkin's lymphoma (NHL) with previous treatment with standard chemotherapy presenting as an acute, ascending, sensorimotor polyneuropathy. Nerve conduction studies and lumbar puncture supported a rare, but ominous, axonal variant of Guillain-Barré Syndrome (GBS) known as acute motor and sensory axonal neuropathy (AMSAN), which is distinguished from the more common, acute demyelinating forms of GBS. Previous reports have largely focused on toxicities secondary to chemo- or radiotherapy as a major contributor to the development of acute neuropathies in malignancy. Clinicians should also be mindful of direct neoplastic invasion or, less commonly, paraneoplastic phenomenon, as alternative mechanisms, the latter possibly reflecting immune dysregulation in particularly aggressive lymphomas. At the time of writing, this is the first report in the literature of an axonal variant of GBS in a patient with diffuse large B cell NHL. A discussion regarding common and uncommon neuropathies in haematological malignancies is made, with a brief review of the anecdotal evidence supporting a paraneoplastic association with GBS or its variant forms in the setting of lymphoma.

Anti-GD1b and anti-GM1 positive, acute inflammatory demyelinating polyneuropathy associated with advanced ovarian carcinoma: A case report

“…According to our research, only a single case-control study described a positive association between GBS and cancer [25]. Guillain-Barré syndrome is mostly associated with lymphomas [26,27]. Solid tumors associated with GBS include small cell lung cancer, breast cancer, renal cancer, hepatocellular carcinoma, tongue carcinoma, esophageal carcinoma, and the ovarian dysgerminoma.…”

Gastric lymphoma complicated by phlegmonous gastritis and Guillain–Barré syndrome

“…In almost all the cases, the condition was reported as paraneoplastic neurological syndrome. [ 29 – 33 ] Even though the present case did not have serum antiganglioside antibodies or cerebrospinal fluid albuminocytologic dissociation, the patient was diagnosed with GBS on the basis of clinical symptoms and the results of nerve conduction studies. This diagnosis is consistent with GBS diagnostic criteria.…”

Burkitt Lymphoma Presenting as a Paraneoplastic Demyelinating Disorder in a Child

“…AIDP and its variants have previously been reported in adults with NHL. [4][5][6][7] We found only two prior reports describing pediatric patients with BL presenting with AIDP; one patient had primary CNS BL where another was found to have an extradural mass with neuromeningeal involvement. 8,9 Our case highlights a rare subtype of AIDP in a young girl with BL and adds to the growing body of literature supporting the need to have a high suspicion for malignancy masquerading as an acute neurologic disorder, particularly if patients have an unusual presentation without clear preceding infection or are not improving as expected on standard therapy…”