Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9502
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
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.
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.
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.