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Case Reports
. 2025 Feb 17;17(2):e79144.
doi: 10.7759/cureus.79144. eCollection 2025 Feb.

Bing-Neel Syndrome: A Missed Opportunity

David R Drysdale  1 , Mark E Gartner  2 , Ryan A Smith  3 , Bradley J Atoa  4 , Aaron D Fleetwood  5 , Tyson J Sjulin  2 , Michael B Osswald  5
Affiliations
Case Reports

Bing-Neel Syndrome: A Missed Opportunity

David R Drysdale et al. Cureus. .

Abstract

Bing-Neel syndrome (BNS) is a rare complication of Waldenström macroglobulinemia, characterized by lymphoplasmacytic lymphoma infiltration of the CNS. We present a pathologically confirmed case of BNS in a patient who was initially misdiagnosed with COVID-19 pneumonia and critical illness polyneuropathy. This case underscores the diagnostic challenges associated with BNS and highlights the importance of early recognition.

Keywords: bing-neel syndrome; bruton tyrosine kinase inhibitor; ibrutinib; lymphoplasmacytic lymphoma; waldenstrom macroglobinemia.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Brooke Army Medical Center (BAMC) Human Research Protection Program (HRPP) and Regional Health Command-Central (RHC-C) Institutional Research Board (IRB) issued approval 980098. Per the BAMC HRPP and RHC-C IRB, this activity does not meet the definition of research as defined in 32 CFR 219.102(l) as it is not a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge. Submission of an IRB research application is not required. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: This article was previously presented as a meeting abstract at the 2024 TriService American College of Physicians Meeting on September 23rd, 2024, and the 2024 Academic, Industry, Military Health Research and Development Conference on June 24th, 2024. The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Defense Health Agency, the Department of Defense, nor any agencies under the U.S. Government. This project was not funded. The authors declare that there are no conflicts of interest related to this research.

Figures

Figure 1
Figure 1. (A, top middle, red arrows) T1 post-contrast axial view showing smooth pachymeningeal enhancement along the bilateral cerebral convexities. (B, bottom left, red arrow) FLAIR coronal view revealing mild nodular dural enhancement along the mid falx. (C, bottom right, red arrow) Post-contrast coronal view demonstrating mild nodular dural enhancement along the mid falx.
Figure 2
Figure 2. Hemispheric dura and falx demonstrating atypical LPL infiltrate on H&E staining at 200x. (A, top left, red circle) H&E stain showing LPL infiltrate at 40x. (B, top right, red circle) H&E stain showing LPL infiltrate at 200x. (C, bottom left, red circle) CD20-positive staining at 200x. (D, bottom right, red circle) PAX5-positive staining at 200x.
LPL, lymphoplasmacytic lymphoma; PAX5, paired box 5 Image credit: Ryan A. Smith
See this image and copyright information in PMC

References

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