[Paraparesis and sensory spinal cord transection caused by an NK-cell lymphoma].
METHODS
A 42-year-old man of Russian origin was admitted because of fever, nocturnal sweating and weight loss. Within 2 days a paraparesis of the legs and a bladder-colon disorder had developed. Neurological examination suggested a spinal cord lesion at T4 and hypaesthesia from T9 downward.


METHODS
Lymphocytosis was associated with an increase in NK-cells (63% NK-cells; CD16 positive, CD56 negative). Chromosomal findings were: (46 XY ad (1) (P372), ad (3) (P25), DEL (14) Q22 (Q24), RG (5) (RG). Electrophysiological tests indicated a symmetrical prolonged central motor conduction time. Magnetic resonance imaging showed opacification of all nasal sinuses. Histological findings of a biopsy from this site were suspicious of NK-cell lymphoma.


METHODS
The neurological symptoms briefly responded to glucocorticoids, but were resistant to chemotherapy. Plasmapheresis, undertaken on the tentative diagnosis of paraneoplastic protein secretion, brought definite improvement in the overall condition. A highly malignant lymphoma was diagnosed 12 months later. It, too, proved to be treatment-refractory.


CONCLUSIONS
A cerebrospinal tap should be routinely performed in patients with NK-cell lymphoma. In view of the poor prognosis, early escalation of treatment should be considered.
Seifart
C
C
Innere Medizin, Klinik für Pneumologie, Germany.
Seifart
U
U
Neubauer
A
A
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D004553:Electric Conductivity; D017809:Fatal Outcome; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007694:Killer Cells, Natural / Q000473:pathology*; D008223:Lymphoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D010256:Paranasal Sinuses / Q000473:pathology*; D020335:Paraparesis / Q000209:etiology*; D010956:Plasmapheresis; D011239:Prednisolone / Q000627:therapeutic use
D005938:Glucocorticoids; D011239:Prednisolone