See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/7233655 Guillain-Barre syndrome: An unusual presentation of intravascular lymphoma Article in The Israel Medical Association journal: IMAJ · March 2006 Source: PubMed CITATIONS READS 9 60 3 authors , including: Shaye Kivity Yechezkel Sidi Sheba Medical Center Tel Aviv University 111 PUBLICATIONS 2,865 CITATIONS 266 PUBLICATIONS 3,533 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: miRNA in psorasis View project regulation of immune check point genes by mirnas View project All content following this page was uploaded by Shaye Kivity on 01 October 2015. The user has requested enhancement of the downloaded file.
137 mal differential, platelets 198,000 mm 3 , polyneuropathy compatible with Guillian- progressive bilateral acute sensory motor tion; electromyography demonstrated a proximally,accompaniedbyurinaryreten- The leg weakness rapidly progressed thyorhepatosplenomegaly. scans did not reveal any lymphadenopa- Head and body computed tomography kaline phosphatase were mildly elevated. ferase,aspartateaminotransferaseandal- sodium 121 mmol/L; alanine aminotrans- white blood cells 3900 mm 3 with nor- not significant except for mildly elevated D-dimer 1890 mg/L, hemoglobin 9.1 g/dl, mm/hour, lactate dehydrogenase 450 U/L, ing: erythrocyte sedimentation rate 100 ratory examination revealed the follow- was taken from one of the lesions. Labo- aspects of the thighs. A second biopsy plaques were observed on both lateral no neck stiffness. Large painful reddish weakness and parasthesia (L>R) with revealed agitation, bilateral distal leg On admission, her body temperature noresponseafter3daysoftherapy. Barre syndrome. Lumbar puncture was protein (62 mg/dl). Spinal magnetic reso- A week prior to hospitalization she had lymphoma [Figure]. Revision of the first IMAJ2006;8:137–138 Keywords: intravascularlymphoma,Guillain-Barresyndrome,erythemanodosum Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel Departmentsof 1 MedicineCand 2 Pathology,ShebaMedicalCenter,TelHashomer,Israel ShayeKivity MD 1 ,BruriaShalmon MD 2 andYechezkelSidi MD 1 flammatory demyelinating polyneuropathy Barresyndromeisanidiopathicacutein- with Guillian-Barre syndrome. Guillian- of intravascular lymphoma presenting To our knowledge this is the first report hadbeenpresent2yearsearlier. biopsydisclosedthatthesamepathology confirmed the diagnosis of intravascular nanceimagingdidnotyieldanyfindings. Immunohistochemical stains for CD20 dermal and subcutaneous blood vessels. lymphoidcellsfilling the lumens of small had died, demonstrated large atypical which were received after the patient from the red plaques, the results of and multi-organ failure. Skin biopsies cillin-resistant Staphylococcus aureus sepsis succumbing 10 days later due to methi- response. She continued to deteriorate, gammaglobulins for 5 days, without any The patient was treated with intravenous family doctor prescribed quinolones, with high fever and distal leg numbness. Her nodosum. She received no treatment. rologic manifestations, and progressive are diagnosed postmortem and delayed prior case studies, 75% of the patients few hundred case reports. According to thelomatosis). It is described in only a endothelial origin (malignant angioendo- takenly in the past to be a neoplasia of This lymphoma was considered mis- disturbances[1] dents, peripheral neuropathies and visual dementia, seizures, cerebrovascular acci- tations include headaches, depression, multisystem failure. Neurologic manifes- origin, non-specific cutaneous and neu- for the poor prognosis. Moreover, it is patients present with fever of unknown and small vessels by tumor cells. Most to multifocal involvement of medium of the disease are protean and are due nervous system. Clinical manifestations the vasculature of the skin and central The lymphoma preferentially involves of small vessels, particularly capillaries. of lymphoma cells only in the lumina lymphoma characterized by the presence type of extranodal diffuse large B cell Intravascular lymphoma is a rare sub- Guillain-BarreSyndrome diagnosed as having idiopathic erythema diagnosis is common, accounting in part assumed that many patients are never an acute febrile disease and bilateral leg chronicinflammation. Since then she was with fat necrosis and slight perivascular pretedasnon-specific lobular panniculitis taken a year before admission was inter- Histopathologic examination of a biopsy nodosum-like lesions on both thighs. from multiple large painful, erythema rin .During the last 2 years she suffered was treated with beta-blockers and aspi- hypertension of 5 years duration that diagnosed. Most of the diagnoses in live numbness. Past medical history revealed A 78 year old woman was admitted with no preferred therapeutic protocol recom- patients were made by skin biopsy, and thefewpatientswhoreceivedchemother- apy lived months to years longer than untreated patients [2]. To date, due to the lack of randomized studies, there is mended for intravascular lymphoma. The present report demonstrates the difficulty in early diagnosis and describes Guillian- Barre syndrome as the presentation of thisunusuallymphoma. Case Communications Guillain-Barre Syndrome: An Unusual Presentation of Intravascular Lymphoma Patient Description was 39.1 ° C, her neurologic examination Comment • Vol 8 • February 2006
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