Objective:

We present a case of sensorimotor peripheral neuropathy in a patient with T-cell lymphoma.

Background:

Neurolymphomatosis is a rare manifestation of lymphoma (0.2% of cases), in which the lymphomatous cells infiltrate the endoneurium of nerve roots, plexuses, or peripheral nerves. Most cases are seen with B-cell Non-Hodgkin's lymphoma with sporadic reported cases occurring in T-cell lymphoma. We present a case of neurolymphomatosis due to T-cell lymphoma. 

Design/Methods:

Case report

Results:

A 69-year-old male presented to the Emergency Department (ED) with left lower extremity (LLE) weakness and pain. In the previous 2 months, he had presented to the ED twice with paresthesias and lower extremity edema. Vitals were unremarkable. Labs were significant for Na 128, CRP 17, ESR 77, and D-dimer 1,373. CT Lumbar spine was notable for prominent bilateral retroperitoneal and iliac lymph nodes. On neurological exam, mental status and cranial nerves were normal. Motor examination showed 0/5 strength in the distal LLE and 4/5 on R plantar flexion. Sensory exam was significant for asymmetric decreased sensation to pinprick in the legs with sensation intact above the malleolus at 5” on the right and 6” on the left with associated hair loss. Vibration sense was absent at both knees and fingertips. There was proprioception loss in the left great toe. His ankle jerks were reduced. He had a broad-based, high steppage gait. CSF was remarkable for protein of 366. EMG/NCS demonstrated asymmetric demyelinating neuropathy. He failed IVIG. CT C/A/P demonstrated extensive lymphadenopathy with possible peritoneal carcinomatosis. Serum paraneoplastic panel was negative. Left groin excisional biopsy pathology confirmed angioimmunoblastic T-cell lymphoma. Patient was started on infusions of doxorubicin and cyclophosphamide. MRI L-spine with and without contrast is pending to assess for nerve root enhancement.  

Conclusions: