Guillain-Barré syndrome in a patient with non-Hodgkin's lymphoma

Abstract

We describe a case of Guillain-Barré syndrome (GBS) in a patient with non-Hodgkin's lymphoma (NHL). A 21-year-old woman with a newly diagnosed stage IV high-grade lymphoma (precursor T-cell NHL according to the R.E.A.L. Classification) developed flaccid quadriparesis and bilateral facial diplegia after three weeks of treatment with vincristine, daunorubicin, L-asparaginase and prednisolone. The clinical course and neurological examination were consistent with GBS. Despite treatment with intravenous immunoglobulins her neurological symptoms progressed. Plasmapheresis was therefore initiated followed by intravenous immunoglobulins. After partial remission of neurologic symptoms, induction chemotherapy with cyclophosphamide and cytarabine was continued without any further complication. Three months later, the lymphoma was in complete remission. GBS has been described in Hodgkin's disease and after bone marrow transplantation but is rare in NHL. In patients with NHL who develop neurological symptoms, drug toxicity and nervous system infiltration are the leading cause of neuropathology, but GBS should be considered in the differential diagnosis.

Lymphoma-associated dysimmune polyneuropathies

“…The type of lymphoma varied, and included 11 patients with HL, 7 patients with CLL, with various subtypes of NHL comprising the remainder. Thus, this collected case report information could not support published statements that HL (more than other types of lymphoma) is more commonly associated with immunemediated polyneuropathies [1,3,87,102].…”

“…(2) In most patients, lymphoma was diagnosed before the development of GBS. Also this temporal correlation varied, so that the onset of GBS developed: (a) with lymphoma relapse [70,77,78,88,89,101]; (b) during lymphoma maintenance therapy [74]; (c) at varying intervals (2 weeks and 3 months) after completion of chemotherapy for lymphoma deemed in remission [72,73,75,76,82]; (d) while undergoing (interval 6 days to 3 weeks) chemotherapy for lymphoma (cycles #1 to #6) [91,93,95,97,98]; (e) after induction chemotherapy for lymphoma (interval 11 to 16 days) [87,96], or (f) during the course (as long as 10 years) of indolent disease not under active treatment e.g., CLL [73,86,101].…”

Paraneoplastic syndromes of the peripheral nerves

“…Acute mortality was significantly higher in the patients with GBS and cancer compared with those with GBS alone. AIDP also heralded the recurrence of tongue carcinoma [4] and ovarian dysgerminoma [14], and developed within 0-3 months of discovering breast cancer [15] and non-Hodgkin's lymphoma [16]. A relapsing demyelinating neuropathy occurred in a woman with clear cell carcinoma of the kidney, the first two attacks occurring within a month of being diagnosed, and a relapse heralding widespread and ultimately fatal metastatic disease [17].…”

CD5-Positive Diffuse Large B Cell Lymphoma Infiltrating the Central Nervous System Presenting Guillain-Barr^|^eacute;-Like Syndrome after Chemotherapy

“…In any case, GBS due to the infiltration of lymphoma cells in the CSF was not seen. 9,[14][15][16][18][19][20][21][22] In our DLBCL case, which was difficult to distinguish from IVL, GBS-like symptoms were also seen after chemotherapy. However, the accumulated dosage of vincristine was not more than 4 mg, 23 antecedent symptoms, such as diarrhea due to Campylobacter jejuni, were not seen, and CSF examination indicated lymphoma cell invasion.…”