Article thumbnail

Hodgkin's Lymphoma and Paraneoplastic Phenomena in the Central Nervous System: A Case Report and Review of the Literature

By Marcus Vetter, Alexandar Tzankov, Andreas Engert, Matthias Mehling, Richard Herrmann and Christoph Rochlitz

Abstract

A 25-year-old male patient presented to our Ear, Nose and Throat clinic with a history of nausea, vomiting, headache, vertigo and weight loss of 5 kg over the preceding 3 months. An enlarged cervical lymph node was detected at clinical examination. Lymph node biopsy showed nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL, nodular paragranuloma). Because of the neurological symptoms a cerebral MRI scan was performed and revealed an intense perivascular, bilateral, contrast-medium enhancing lesion of the temporal lobes suggestive of cerebral vasculitis. Cerebrospinal fluid analysis showed an increased number of mononuclear cells, but there was no indication for neurotropic viral or bacterial infections. EEG revealed a left temporal epileptic focus, and anti-epileptic therapy was initiated. NLPHL was treated with 2 cycles of ABVD chemotherapy and 20 Gy involved-field radiotherapy. Steroid therapy (prednisone 100 mg q.d.) for the presumed paraneoplastic neurological manifestation was started 1 week before chemotherapy and led to the rapid disappearance of complaints. Because of renewed onset of nausea and vertigo after 3 weeks of treatment with ABVD chemotherapy and 4 weeks of treatment with steroids, a follow-up brain MRI and EEG were performed and demonstrated complete disappearance of the ‘vasculitic’ changes without additional pathologic findings. Five months after therapy, the patient is without neurological symptoms and a PET-CT showed a complete remission. This case is a unique example of paraneoplastic central nervous system (CNS) involvement in a patient with newly diagnosed NLPHL. We present a review of the literature on paraneoplastic CNS symptoms in Hodgkin's lymphoma

Topics: Published: February 2011
Publisher: S. Karger AG
OAI identifier: oai:pubmedcentral.nih.gov:3072188
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles

Citations

  1. A: Primary angiitis of the central nervous system as a first presentation in Hodgkin’s disease: a case report and review of the literature. Neurosurgery 2000;46:1504–1508, discussion
  2. (1957). Allergic granulomatous angiitis. Arch Klin Exp Dermatol
  3. (1996). Avvisati G: Meningeal localization in a patient with Hodgkin’s disease: description of a case and review of the literature. Ann Oncol
  4. Cerebrospinal fluid infiltration in Hodgkin lymphoma: a case report.
  5. Delanty N: Hodgkins disease presenting with granulomatous angiitis of the central nervous system.
  6. (2002). Diagnostic and therapeutic quandaries in primary manifestation of Hodgkin's disease in the central nervous system. Ann Hematol
  7. EL: Lymphoma-associated retinopathy.
  8. Granulomatous angiitis of the central nervous system revealing Hodgkin's disease.
  9. (1980). Guillain-Barré syndrome and Hodgkin’s disease – ultrastructural study of a peripheral nerve.
  10. HD: Hodgkin’s disease and granulomatous angiitis of the central nervous system.
  11. Intracerebral Hodgkin’s lymphoma in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma: a case report and literature review.
  12. Myasthenia gravis remission and anti-AChR ab reduction after immunosuppressive and anti-neoplastic therapy in a patient with thymic Hodgkin’s disease.
  13. Nighoghossian N: Recurrent cerebral venous thrombosis revealing paraneoplastic angiitis in Hodgkin’s lymphoma.
  14. Paraneoplastic and oncologic profiles of patients seropositive for type 1 antineuronal nuclear autoantibodies.
  15. (1992). Paraneoplastic cerebellar degeneration. II. Clinical and immunologic findings in 21 patients with Hodgkin’s disease.
  16. Relapsing granulomatous angiitis of the central nervous system in a patient while in remission from Hodgkin lymphoma.
  17. TT: CNS Hodgkin lymphoma.
  18. V: CNS involvement in Hodgkin’s lymphoma.
  19. (2006). Yorioka N: A case report of plasmapheresis in paraneoplastic cerebellar ataxia associated with anti-Tr antibody. Ther Apher Dial