Splenic marginal zone lymphoma: An indolent malignancy leading to the development of neurolymphomatosis.
Acute neuropathic pain and weakness with a sensory level in a patient with a history of lymphoma has a broad differential diagnosis. Evaluation of such a presentation often includes MRI, neurophysiologic studies, and cerebrospinal fluid evaluation. We report a patient with splenic marginal zone lymphoma who developed acute weakness, sensory loss, and neuropathic pain due to neurolymphomatosis.



Clinical evaluation, MRI of the lumbar spine, cerebrospinal fluid evaluation, electrodiagnostic (EDx) studies, and biopsy of a dorsal nerve root were undertaken.



EDx studies were consistent with an acute, acquired demyelinating sensorimotor polyradiculoneuropathy. Treatment with intravenous immunoglobulin and plasma exchange did not lead to clinical improvement. Ultimately, biopsy of a dorsal nerve root was performed and revealed neurolymphomatosis.



This case emphasizes that, when it can be performed safely, biopsy for suspected neurolymphomatosis is imperative for appropriate diagnosis and treatment. Muscle Nerve 55: 440-444, 2017.
Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, Virginia, 22908, USA.
Christopher L
CL
Groth
Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, Virginia, 22908, USA.
Kathryn S
KS
Nevel
Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, Virginia, 22908, USA.
Kelly G
KG
Gwathmey
Department of Pathology, University of Virginia, Charlottesville, Virginia, USA.
Fahad
F
Bafakih
Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, Virginia, 22908, USA.
David E
DE
Jones
D000818:Animals; D002420:Cauda Equina / Q000000981:diagnostic imaging*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008223:Lymphoma / Q000134:cerebrospinal fluid / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008380:Marek Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D009369:Neoplasms; D009431:Neural Conduction; D010951:Plasma Exchange / Q000379:methods
D016756:Immunoglobulins, Intravenous
Guillain-Barré syndrome; electromyography and nerve conduction studies; magnetic resonance imaging; nerve biopsy; neurolymphomatosis; splenic marginal zone lymphoma