Zhou QL, Li ZK, Xu F, Liang XG, Wang XB, Su J, Tang YF. Guillain-Barré syndrome and hemophagocytic syndrome heralding the diagnosis of diffuse large B cell lymphoma: A case report. World J Clin Cases 2022; 10(26): 9502-9509 [PMID: 36159426 DOI: 10.12998/wjcc.v10.i26.9502]
Corresponding Author of This Article
Fang Xu, MD, Academic Fellow, Chief Doctor, Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12 Changjia Alley, Jingzhong Street, Fucheng District, Mianyang 621000, Sichuan Province, China. 147377807@qq.com
Research Domain of This Article
Hematology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Qiao-Lin Zhou, Fang Xu, Xiao-Gong Liang, Jing Su, Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
Zhao-Kun Li, Yu-Feng Tang, Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
Xing-Biao Wang, Department of General Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
Author contributions: Zhou QL and Xu F contributed to manuscript writing and editing, and data collection; Li ZK contributed to data analysis; Liang XG, Wang XB, Su J and Tang YF contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fang Xu, MD, Academic Fellow, Chief Doctor, Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12 Changjia Alley, Jingzhong Street, Fucheng District, Mianyang 621000, Sichuan Province, China. 147377807@qq.com
Received: May 11, 2022 Peer-review started: May 11, 2022 First decision: June 16, 2022 Revised: June 26, 2022 Accepted: August 6, 2022 Article in press: August 6, 2022 Published online: September 16, 2022 Processing time: 100 Days and 14.4 Hours
Abstract
BACKGROUND
Central nervous system (CNS) lesions and peripheral neuropathy are rare among patients with non-Hodgkin's lymphoma (NHL). Lymphomatous infiltration or local oppression usually accounts for CNS or peripheral nerve lesions. The incidence of peripheral neuropathy was 5%. Guillain-Barré syndrome (GBS) is rare and may occur in less than 0.3% of patients with NHL. Hemophagocytic syndrome (HPS) is a rare complication of NHL. It has been reported that 1% of patients with hematological malignancies develop HPS. Diffuse large B-cell lymphoma (DLBCL) combined with GBS has been reported in 10 cases.
CASE SUMMARY
We report the case of a 53-year-old man who was initially hospitalized because of abnormal feelings in the lower limbs and urinary incontinence. He was finally diagnosed with DLBCL combined with GBS and HPS after 16 d, which was earlier than previously reported. Immunoglobulin pulse therapy, dexamethasone, and etoposide were immediately administered. The neurological symptoms did not improve, but cytopenia was relieved. However, GBS-related clinical symptoms were relieved partially after one cycle of rituximab - cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (R-CHOP) chemotherapy and disappeared after six cycles of R-CHOP.
CONCLUSION
GBS and HPS heralding the diagnosis of Epstein-Barr virus DLBCL are rare. Herein, we report a rare case of DLBCL combined with GBS and HPS, and share our clinical experience. Traditional therapies may be effective if GBS occurs before lymphoma is diagnosed. Rapid diagnosis and treatment of DLBCL are crucial.
Core Tip: Guillain-Barré syndrome (GBS) is uncommon in diffuse large B-cell lymphoma (DLBCL). GBS and hemophagocytic syndrome (HPS) heralding the diagnosis of Epstein-Barr virus DLBCL are clinically rare. Herein, we report a rare case of DLBCL complicated with GBS and HPS. We also analyze the reported cases extracted in PubMed in terms of all the possible etiologies of GBS. Traditional therapies may be ineffective in patients who develop GBS before lymphoma is diagnosed. Rapid diagnosis and treatment of DLBCL are crucial.
