Rapid improvement of paraplegia caused by epidural involvements of Burkitt's lymphoma with chemotherapy.
METHODS
Case report.


OBJECTIVE
The authors present a case of atypical Burkitt's lymphoma with multiple epidural involvements.


BACKGROUND
Spinal cord compression in children is an emergency that requires urgent attention to minimize neurologic dysfunction. Although it is not life-threatening in most patients, cord compression can cause severe neurologic morbidity.


METHODS
Because the patient showed rapid neurologic deterioration, we started chemotherapy and high-dose steroids without laminectomy or radiotherapy immediately after a tumor biopsy from the left mandible.


RESULTS
The combined therapies were very effective and his neurologic symptoms improved immediately. The epidural involved masses disappeared in imaging studies after the first course of chemotherapy including methylprednisolone (20 mg/kg per day for 3 consecutive days and gradually tapered off over 2 weeks), vincristine (1.5 mg/m2 per day), cyclophosphamide (2 g/m2 per day for 2 days) and pirarubicin (40 mg/m2 per day). After completing seven courses of chemotherapy, the patient is now fully ambulant.


CONCLUSIONS
Considering the severe late effects of laminectomy and radiotherapy, chemotherapy should be considered as a first choice of treatment for spinal cord compression caused by malignant lymphoma.
Matsubara
Hiroshi
H
Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan. hrmatsub@kuhp.kyoto-u.ac.jp
Watanabe
Ken-ichiro
K
Sakai
Hidemasa
H
Chang
Hsi
H
Fujino
Hisanori
H
Higashi
Yuri
Y
Kobayashi
Michihiro
M
Adachi
Souichi
S
Seto
Shiro
S
Nakahata
Tatsutoshi
T
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002051:Burkitt Lymphoma / Q000150:complications* / Q000188:drug therapy; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015174:Epidural Neoplasms / Q000150:complications* / Q000188:drug therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007866:Leg; D008159:Lumbar Vertebrae; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010264:Paraplegia / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D005938:Glucocorticoids; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; C027260:pirarubicin; D008775:Methylprednisolone