Bilateral Numb Chin Syndrome as the Initial Presentation of Burkitt’s Lymphoma/Leukemia: A Report of Two Cases and Review of the Literature

Abstract

Numb chin syndrome, also known as mental nerve neuropathy, is a rare sensory neuropathy characterized by paresthesia and hypoesthesia in the area supplied by the mental nerve and its branches. This syndrome may be the first symptom of underlying malignancy or the first sign of recurrence and metastasis in patients with preexisting cancer. In this article, we present two cases with bilateral numb chin syndrome as the first manifestation of Burkitt's lymphoma/leukemia and review the relevant literature. Numb chin syndrome should be considered as a warning sign and raise the suspicion for an underlying malignancy. Bilateral involvement is especially hazardous and must not be underestimated. In fact, an astute neurologist and internist who realizes that chin numbness is a potentially significant symptom can then exclude serious underlying malignancies. Standard diagnostic protocol with different modalities of imaging based on the availability and experience of the radiology team should be mandatory. High index of suspicion should be practiced to avoid delay in diagnosis and progression of the underlying malignancy.

Numb chin syndrome as a presenting symptom of diffuse large B-cell lymphoma with secondary myelofibrosis

“…Bilateral as compared with unilateral chin involvement is more commonly associated with haematopoietic malignancies than solid organ malignancies 9. This has been previously attributed to higher propensity for central nervous system (CNS) involvement in haematological malignancies 10. However, bilateral mandibular metastasis with neural infiltration can also lead to bilateral NCS and was the likely aetiology in the present case.…”

Why is That Chin Numb? A Case of Burkitt’s Lymphoma Presenting as Numb Chin Syndrome

“…At the same time, NCS in the absence of any identifiable cause should raise suspicion for underlying malignancy and brain imaging should be pursued to look for metastasis. CT or an MRI of the brain may show metastatic brain lesions or even leptomeningeal involvement; however, MRI is considered superior to CT scan while evaluating the etiology of NCS [1].…”

“…The numb chin syndrome (NCS) is a rare neurological condition characterized by localized numbness and prickling sensation in the skin of the chin and lower lip, limited to the region served by the mental nerve [1]. The first case of this syndrome was introduced in 1830 by Charles Bell [2].…”

“…NCS has also been associated with other systematic diseases such as diabetes and multiple sclerosis. It usually presents unilaterally, but bilateral manifestations have also been reported [1].…”

Late recurrence of Burkitt s lymphoma in the jaw: numb chin syndrome as the only symptom

“…These symptoms reflect the anatomical substrate of this syndrome. 1,2 Despite being a rare clinical manifestation, the importance of this syndrome lies in its frequent association with malignancies. 3 The most common non-hematologic neoplastic cause of NCS is breast cancer, while the most common hematologic neoplastic cause is non-Hodgkin lymphoma (NHL).…”