Gullain-barre Syndrome Associated with Non-Hodgkin's Lymphoma

Abstract

A 67-year-old man developed swelling of the right leg with inguinal and abdominal pain over a period of 5 days. Excisional biopsy of the left supraclavicular lymph nodes revealed the diffuse, large B cell type of malignant lymphoma. After chemotherapy, he complained of a tingling sensation and weakness in the left upper extremity, and then this progressed to quadriplegia. Electrodiagnostic testing demonstrated the characteristic findings of demyelination, which was consistent with Guillain-Barre syndrome (GBS). Non-Hodgkin's Lymphoma (NHL) leading to GBS, as was observed in the present case, suggests that physicians should be aware of GBS and non-Hodgkin's lymphoma as the full spectrum of these diseaseshas not been fully defined. (Korean J Hematol 2008;43:263-267.)

Lymphoma-associated dysimmune polyneuropathies

“…(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].…”

Rare Association of Gullain-Barré Syndrome with Non-Hodgkin’s Lymphoma: A Case Report

“…Five distinct types of polyneuropathy occur as an occasional remote accompaniment of lymphoma-GBS, chronic relapsing inflammatory demyelinating polyradiculoneuropathy (CIDP), paraneoplastic sensory neuropathy, sub acute motor neuropathy and diffuse infiltration of nerves by NHL 11 . However, the differential diagnosis of peripheral neuropathies in NHL depends on the clinical settings and mainly includes drug (chemotherapy) toxicity and nerve infiltration by lymphoma -both of which have been well described 3,12 . Besides these, plexopathy, mononeuropathy, vasculitis and paraproteinemic deposition have all been postulated as the underlying etiology of acute neuropathies in NHL.…”

“…The Guillain-Barré Syndrome and chronic relapsing inflammatory demyelinating polyradiculoneuropathy (CIDP) probably reflect disordered immune regulation 11 . It seems likely that malignant tumors act as sources of the antigenic factors that are responsible for initiating an immune response in the nervous system, later manifesting as GBS 3 . Another theory is that selective depression of cell mediated immunity of any etiology might allow the development of a humoral and or cellular immune reaction directed against peripheral nerve antigens.…”

“…It is characterized by a rapidly ascending muscle weakness or paralysis accompanied by absent or depressed deep tendon reflexes and in some cases, by respiratory distress. Abnormal immune response against target epitopes in Schwann cell surface or myelin (demyelinating form-85%) or epitopes in axonal membrane (acute axonal form-15%) through both humoral and cell mediated mechanisms is the proposed aetiopathogenesis to explain GBS 1,2,3 .…”

“…Many reports have been issued on GBS in association with Hodgkin's disease, but its association with Non-Hodgkin's Lymphoma (NHL) is relatively rare. A few cases of NHL reported developed acute motor neuropathy after or during receiving CHOP chemotherapy for the malignancy attributable to either chemotherapy induced polyneuropathy or demyelinating polyradiculoneuropathy (GBS) 3,9 . We presents a case of acute motor neuropathy, likely GBS, with concomitant incidental finding of generalized lymphadenopathy which was later proven to be a case of NHL.…”