Guillain-Barré Syndrome as First Presentation of Non-Hodgkin's Lymphoma

  • Abolhassan Ertiaei Department of Neurosurgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Mahsa Ghajarzadeh Brain and Spinal Injury Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Azizollah Javdan Department of Neurosurgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Abbas Taffakhori Department of Neurology, Iranian Center of Neurological Research, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Bahaaddin Siroos Department of Neurology, Iranian Center of Neurological Research, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Mohsen Esfandbod Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Hooshang Saberi Department of Neurosurgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Brain and Spinal Injury Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Guillain-Barré syndrome, Non-Hodgkin's lymphoma, Polyradiculopathy

Abstract

We present a woman referred with underlying non-Hodgkin's lymphoma (NHL) masquerading clinically with Guillain-Barré syndrome (GBS) like syndrome. At first evaluation, chest CT-Scan along with brain and whole spine MRI were normal. Electrodiagnostic studies were in favor of acute generalized polyradiculoneuropathy. Laboratory evaluation revealed hypoglycorrhachia. She treated with plasmapheresis after two weeks; she was discharged from hospital, but neurological recovery was not complete. After 6 months, she came back with acute onset of weakness in lower limbs, back pain, fever and urinary incontinence. Pinprick and light touch complete sensory loss was found beneath umbilicus. Thoracic MRI with contrast revealed a dorsal epidural mass extending smoothly from T8 to T12 (10 cm) with spinal cord compression. She underwent urgent laminectomy for spinal cord decompression. Histological examination revealed small round cell tumor suggestive of malignant T-cell type lymphoma. In cases with Guillain-Barré syndrome presentation, systemic hematologic disorders such as non-Hodgkin's lymphoma should be considered as one of the differential diagnosis of underlying disease.

References

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.

Lee SJ, Suh CW, Lee SI, Kim WS, Lee WS, Kim HJ, et al. Clinical characteristics, pathological distribution, and prognostic factors in non-Hodgkin lymphoma of Waldeyer's ring: nationwide Korean study. Korean J Intern Med 2014;29:352-60.

Kapoor R, Kumar V, Sharma S. Primary extradural non- Hodgkin's lymphoma. JK Science 2006;8:45-8.

Hughes RA, Rees JH. Clinical and epidemiologic features of Guillain-Barré syndrome. J Infect Dis 1997;176:S92-8.

Mally R, Sharma M, Khan S, Velho V. Primary lumbo- sacral spinal epidural non-Hodgkin's lymphoma: a case report and review of literature. Asian Spine J 2011;5:192-5.

Lim CC, Chong BK. Spinal epidural non-Hodgkin's lymphoma: case reports of three patients presenting with spinal cord compression. Singapore Med J 996;37:497-500.

McDonald A, Nicoll J, Rampling R. Non-Hodgkin's lymphoma presenting with spinal cord compression; a clinicopathological review of 25 cases. Eur J Cancer 2000;36:207-13.

Kelly JJ, Karcher DS. Lymphoma and peripheral neuropathy: a clinical review. Muscle Nerve 2005;31:301-13.

Vallat J, De Mascarel H, Bordessoule D, Jauberteau M, Tabaraud F, Gelot A, et al. Non-Hodgkin malignant lymphomas and peripheral neuropathies—13 cases. Brain 1995;118:1233-45.

Re D, Schwenk A, Hegener P, Bamborschke S, Diehl V, Tesch H. Guillain-Barré syndrome in a patient with non- Hodgkin's lymphoma. Ann Oncol 2000;11:217-20.

Kivity S, Shalmon B, Sidi Y. Guillain-Barre syndrome: an unusual presentation of intravascular lymphoma. Isr Med Assoc J 2006;8:137-8.

Polo-Romero F, Sánchez-Beteta P, Perona-Buendía P, Pérez-García A. Guillain-Barré syndrome as first presentation of non-Hodgkin lymphoma. Neurología 2012;27:511-3.

Berciano J, Berciano M, Lafarga M. Cerebrospinal fluid pleocytosis with neutrophil leukocytes in Guillain–Barré syndrome. Eur J Neurol 2004;11:645-6.

Rauschka H, Jellinger K, Lassmann H, Braier F, Schmidbauer M. Guillain–Barré syndrome with marked pleocytosis or a significant proportion of polymorphonuclear granulocytes in the cerebrospinal fluid: Neuropathological investigation of five cases and review of differential diagnoses. Eur J Neurol

;10:479-86.

Codina Puiggrós A, Cervera Radigales C. Síndrome de Guillain-Barré. Med Clín 2002;118:142-5.

Seffo F, Daw HA. Non-Hodgkin lymphoma and Guillain- Barré syndrome: a rare association. Clin Adv Hematol Oncol 2010;8:201-3.

Published
2016-07-09
How to Cite
1.
Ertiaei A, Ghajarzadeh M, Javdan A, Taffakhori A, Siroos B, Esfandbod M, Saberi H. Guillain-Barré Syndrome as First Presentation of Non-Hodgkin’s Lymphoma. Acta Med Iran. 54(7):471-474.
Section
Case Report(s)