Case Report
Copyright ©The Author(s) 2022.
World J Clin Cases. Sep 16, 2022; 10(26): 9502-9509
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9502
Table 1 Diagnostic criteria for diffuse large B cell lymphoma, Guillain-Barré syndrome and hemophagocytic syndrome

Diffuse large B cell lymphoma
Guillain-Barré syndrome[3]
Hemophagocytic syndrome[4]
Diagnostic criteriaDiagnosis is based on WHO Classification of Tumors of Hematopoietic and Lymphoid TissuesBilateral and flaccid weakness of limbs Decreased or absent deep tendon reflexes in weak limbs; Monophasic course and time between onset-nadir 12 h to 28 d; CSF cell count < 50/μL1; CSF protein concentration > normal value1; NCS findings consistent with one of the subtypes of GBS; Absence of alternative diagnosis for weaknessThe diagnosis HLH can be established if either 1 or 2 below is fulfilled: (1) A molecular diagnosis consistent with HLH; and (2) Diagnostic criteria for HLH fulfilled five out of the eight criteria below. (A) Initial diagnostic criteria (to be evaluated in all patients with HLH); Fever; Splenomegaly; Cytopenias (affecting 2 of 3 lineages in the peripheral blood): Hemoglobin < 90 g/L (in infants < 4 wk: Hemoglobin < 100 g/L). Platelets < 100 × 109/L. Neutrophils < 1.0 × 109/L; Hypertriglyceridemia and/or hypofibrinogenemia: Fasting triglycerides 3.0 mmol/L (i.e., 265 mg/dL); Fibrinogen < 1.5 g/L; Hemophagocytosis in bone marrow or spleen or lymph nodes; No evidence of malignancy. (B) New diagnostic criteria; Low or absent NK-cell activity (according to local laboratory reference); Ferritin 500 mg/L; Soluble CD25 (i.e., soluble IL-2 receptor) 2400 U/mL
Table 2 Reported cases of diffuse large B cell lymphoma combined with Guillain-Barré syndrome
Publication year
Age (yr)/gender
Type of GBS
Immune performance
Nerve conduction studies
Onset of GBS
Treatment of GBS and lymphoma
Response to treatment with IVIG/plasmapheresis
12015AustraliaF/72AMSANNegativeAbsent sensory and motor responses and decreased amplitude in the upper and lower limbs, absent H reflexes, and reduced F waves in the upper and lower limbsAfter chemotherapyGBS: IVIG, 400 mg/kg/dx 5 d. Lymphoma: R-CHOP, radiotherapyProgress is fast, dead[1]
22013PakistanM/70UnknownUnknownUndetectable H reflexes, prolonged distal motor latencies in the right tibial, right ulnar, and bilateral median nerves, evidence of a conduction block in the right tibial nerve. Electromyography (EMG) showed no evidence of denervationBefore chemotherapyGBS: IVIG 1 g/kg. Lymphoma: R-CHOPYes, recurrence of GBS, dead[9]
32013GermanyM/75UnknownGM2 IgMAxonal-demyelinating sensorimotor polyneuropathy was accentuated in the legs and the sensory systemAfter chemotherapyGBS: IVIG, 30 g/dx 3 d, plasmapheresis. Lymphoma: R-CHOPNo[10]
42015ChinaM/65Atypical, the exact type is unknownUnknownUnknownSpinal cord compressionMethylprednisolone, 500 mgUnknown[11]
52012JapanF/83UnknownUnknownUnknownAfter chemotherapyGBS: IVIG, steroid pulse (the dosage is unknown). Lymphoma: CHOP, R-CHOPYes, CMV infection, dead[12]
62019JapanM/67UnknownUnknownProlonged distal motor latencies in the median and ulnar nerves and decreased motor and sensory nerve conduction velocities in the median, ulnar, and tibial nervesBefore chemotherapyGBS: IVIG, 400 mg/kg/dx 5 d. Lymphoma: High-dose CTXNo, dead[13]
72020USAM/67UnknownNegativeUnknownAfter chemotherapyGBS: IVIG, 400 mg/kg/dx 5 d. Lymphoma: R-DA-EPOCHYes, Residual neurological deficits present[14]
82019ChinaunknownUnknownGM1 IgM, GD1b IgMAbsent sensory action potentials in the lower limbsUnknownUnknownUnknown[15]
92012United StatesM/61Miller Fisher syndrome (MFS)NegativeProlonged distal motor latency (right median, ulnar, and tibial motor nerves), slowed motor nerve conduction velocity (right median and tibial motor nerves), prolonged minimum F-wave latencies (right median, ulnar, and tibial nerves), or absent F-waves (left fibular nerve)Before chemotherapyGBS: IVIG, 400 mg/kg/dx 5 d. Lymphoma: R-CHOPYes, recurrence of GBS, improved after chemotherapy, died of pulmonary embolism[16]
102018JapanF/48GBS-likeUnknownUnknownNeurolymphomatosisGBS: IVIG, steroid pulse (dosage is unknown). Lymphoma: R-CHOPYes, recurrence of GBS, dead[17]
112020JapanM/70UnknownUnknownThe amplitude of compound muscle action potentials was reduced, and the F wave's incidence was significantly reduced in the motor nerves (ulnar and median). In the sensory nerves (ulnar, median, and radial), the amplitude of sensory nerve potentials was in the lower limits of normalAfter chemotherapy (combined with phlegmonous gastritis)GBS: IVIG, 400 mg/kg/dx 5 d. Lymphoma: R-CHOPYes[18]
122006SpainM/57UnknownUnknownA severe reduction in amplitude of motor evoked potentials in the right peroneal and posterior tibial nerves, with a moderate decrease in the left median and cubital nervesAfter chemotherapyGBS: IVIG, 400 mg/kg/dx 5 dLymphoma: Splenectomy, CHOP, radiotherapy, R maintenanceYes[19]