Paraneoplastic Necrotizing Myelopathy in a Patient With Newly Diagnosed Diffuse Large B Cell Lymphoma

Abstract

Paraneoplastic neurological disorders are rare but particularly devastating forms of paraneoplastic syndromes, in part due to the fact that the entity is not usually considered as the initial differentials of a cancer patient presenting with neurological symptoms. We report a case of paraneoplastic necrotizing myelopathy associated with Diffuse Large B-cell Lymphoma in an elderly Chinese lady. After extensive investigations, the diagnosis was confirmed on spinal cord biopsy which showed extensive necrotic tissue and absence of tumour or vascular involvement.

Keywords: Diffuse large B-cell lymphoma; Paraneoplastic myelopathy.

Figure 1

(a) Selected sagittal MR image of the thoracic spine on initial presentation showed normal cord signal. (b) Cervical cord on presentation showed normal MR signal.

Figure 2

(a) MRI of the spine 1 week after presentation showed diffuse high T2 signal from the spinal cord from T6 to the conus compatible with cord edema. (b) Selected corresponding axial MR image showed edema across the whole cross-section of the spinal cord.

Figure 3

(a) MRI of the spine showing cord edema progressing cranially to involve the cervical spine. (b) MRI demonstrated edema involving the conus medullaris.

Figure 4

Selected sagittal MR image of the cervical and upper thoracic spine after treatment with methyprednisolone and resumption of chemotherapy, showed near resolution of the abnormal cord signal.