Critical Care: Fellow Case Report Poster - Critical Care II |

“I Can't Walk”: An Unusual Presentation of Burkitt’s Lymphoma FREE TO VIEW

Anthony Andriotis, MD; Nahreen Ahmed, MD; Anna Nolan, MD
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New York Univeristy School of Medicine, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):248A. doi:10.1016/j.chest.2016.08.261
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SESSION TITLE: Fellow Case Report Poster - Critical Care II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Burkitt’s lymphoma accounts for less than 3% of adult lymphomas. It is often extranodal; the abdomen is the most common site of involvement. Patients typically present with B symptoms and abdominal complaints. We present a rare case where Burkitt’s lymphoma presented with progressive weakness and respiratory failure.

CASE PRESENTATION: 64 year old male presented with increasing fatigue, decreased appetite and multiple falls for a few weeks. He initially had trouble walking which quickly progressed to diffuse weakness, areflexia and respiratory failure requiring intubation. He subsequently went into distributive shock and multi-organ failure. Despite persistent fevers, his infectious workup, including an HIV test, was negative. CT scan showed bilateral perinephric soft tissue thickening and an enlarged aortocaval lymph node. MRI of the brain and cervical spine without contrast were significant for enlarged posterior cervical lymph nodes. CSF cell count, glucose, and cultures were normal, but protein was elevated to 606 mg. Cytology was negative. LDH was >3000 and uric acid was elevated to 30.9. A bone marrow biopsy diagnosed Burkitt’s lymphoma. He received high dose steroids, cytoxan and intrathecal chemotherapy. After 1 week, he began to show signs of neurologic improvement, but ten days later, he developed neutropenic sepsis and died.

DISCUSSION: Approximately 15-25% of patients with Burkitt’s present with CNS involvement. To our knowledge, this is the first reported case of an adult patient with Burkitt’s lymphoma presenting with acute progressive peripheral motor neuropathy. We suspect this was due to lymphomatous meningitis (LM) vs. a Guillain-Barré-like syndrome, the latter of which has only been described in B-cell lymphoma patients after receiving chemotherapy, and tends not to respond to traditional therapies for GBS. LM typically requires positive cytology; multiple LPs are usually needed as the sensitivity of a single LP is only 50-60%, and rises to >90% after 3 LPs. Systemic and intrathecal chemotherapy are mainstays of treatment for LM and this GBS-like syndrome, however both have a poor prognosis.

CONCLUSIONS: There should be a high level of suspicion for aggressive B-cell lymphomas in patients with B symptoms and rapid neurologic deterioration, as they require prompt diagnosis and initiation of chemotherapy.

Reference #1: Bomgaars,L et al. “Leptomeningeal Metastases” Cancer in the nervous system. Victor Levin. Oxford University Press 2002. 375-393.

DISCLOSURE: The following authors have nothing to disclose: Anthony Andriotis, Nahreen Ahmed, Anna Nolan

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