title: Late onset malnutrition from esophageal and phrenic dysfunction after radiotherapy for Hodgkin's lymphoma: a case report.
abstract: Radiotherapy may lead to late-onset, rare, but sometimes life-threatening complications that need to be recognized for timely management. We report the case of a 39-year-old man who presented with a 20-kg weight loss with severe dysphagia and respiratory failure. His medical history was noticeable for Hodgkin's lymphoma that was treated 20 y previously. The physical examination and electroneuromyography indicated vagal and phrenic neuropathies. We concluded that the patient had late-onset esophageal motor disorder and bilateral phrenic paralysis secondary to the radiotherapy received 20 y previously for the lymphoma. The patient's management included long-term nutritional support. Although late-onset vagal and phrenic nerve injuries have been described separately after radiotherapy, we report the first case of paralysis at both sites. Another striking feature of this observation is the subsequent severe malnutrition that accompanied these paralyses.
authors.affiliation: CHRU de Tours, Service de Médecine Interne et Nutrition, Hôpital Bretonneau, Tours, France.
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Buzelé
authors.forename: David
authors.initials: D
authors.lastname: Jacobi
authors.forename: François
authors.initials: F
authors.lastname: Maillot
authors.forename: Julie
authors.initials: J
authors.lastname: Magnant
authors.forename: Charles
authors.initials: C
authors.lastname: Couet
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000150:complications* / Q000503:physiopathology; D006689:Hodgkin Disease / Q000473:pathology* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D018529:Nutritional Support; D010791:Phrenic Nerve / Q000528:radiation effects*; D012133:Respiratory Paralysis / Q000150:complications* / Q000503:physiopathology; D015431:Weight Loss