Nodal Peripheral T-cell Lymphoma with T Follicular Helper Phenotype Presenting as Chorea During Treatment: A Case Report and Literature Review

Abstract

A 72-year-old man presented with chorea while undergoing treatment for recurrence of nodal peripheral T-cell lymphoma with T follicular helper (TFH) phenotype. An examination by brain N-isopropyl-p-iodoamphetamine (¹²³I-IMP)-single photon emission computed tomography (SPECT) revealed no abnormalities other than a decreased cerebral blood flow (CBF) in the left striatum. After four courses of salvage chemotherapy, his clinical symptoms and asymmetric cerebral perfusion improved, suggesting that the decreased CBF had caused chorea. The significance of brain SPECT has not been fully clarified in patients with chorea-associated malignant lymphoma, warranting further investigations. Brain SPECT is an alternative approach to identify abnormalities in such patients.

Keywords: chorea; peripheral T-cell lymphoma; single photon-emission computed tomography.

Figure 1.

Positron emission tomography and computed tomography findings show the fluorodeoxyglucose uptake into the bilateral supraclavicular, mediastinum, para-aortic, spleen hilum, and right inguinal lymphoma (A-D).

Figure 2.

Flow cytometry revealed that the cluster of differentiation (CD)4+ T-cells in cerebral blood flow were positive for CD3, CD5, and PD1 and negative for CD10 and CD30.

Figure 3.

Gadolinium-enhanced brain magnetic resonance imaging revealed no abnormal findings (A, B). Brain N-isopropyl-p-iodoamphetamine (¹²³I-IMP)-single photon-emission computed tomography showing hypoperfusion (black arrow) in the left striatum compared with that in the right striatum (C) and improvement after salvage chemotherapy (D).