TITLE:
Neurolymphomatosis: A Rare Cause of Multiple Mononeuropathy
AUTHORS:
Gayathri Petluri, Manoj Kumar Goyal, Veenu Singla, Bhagwant Rai Mittal, Uma Nahar, Manish Modi, Nalini Gupta, Dheeraj Khurana
KEYWORDS:
Neurolymphomatosis, FDG PET Scan, Multiple Mononeuropathy, CIDP
JOURNAL NAME:
World Journal of Neuroscience,
Vol.4 No.2,
May
15,
2014
ABSTRACT: Neurolymphomatosis, defined as invasion of cranial nerves and peripheral nerve roots, plexus or nerves by Non Hodgkin’s Lymphoma is a very rare clinical entity. We describe a case of 69 years old gentleman, who presented to us with asymmetric, painful sensorimotor polyneuropathy. He was admitted with 2 months history of dry cough, constitutional symptoms, paraesthesias on right side of face along with painful asymmetrical quadriparesis. Nerve conduction studies were suggestive of asymmetrical sensorimotor axonal and demyelinating neuropathy. Cerebrospinal fluid analysis revealed mild pleocytosis with raised protein. FDG-PET showed intense uptake in both adrenals, abdominal lymph nodes, sacral nerve roots and brachial plexus. Fine needle aspiration cytology of adrenal mass revealed evidence of diffuse large B cell Non Hodgkin’s Lymphoma. As patient succumbed to illness, an autopsy was done, which revealed diffuse large B cell lymphoma involving adrenals, brachial and lumbosacral plexuses. Our report provides important insights into a rare cause of painful demyelinating multiple mononeuropathy and emphasises on increasing role and diagnostic utility of PET imaging in evaluation of patients presenting with multiple mononeuropathy, especially with regards to paraneoplastic or neoplastic causes such as lymphoma.