Sub-acute Demyelinating Polyradiculoneuropathy as an Initial Symptom of Peripheral T Cell Lymphoma, Not Otherwise Specified (PTCL-NOS)

Kazunobu Kawanishi; Yasuyo Ohyama; Yoshitake Kanai; Tikara Hirase; Hirokazu Tanaka; Junichi Miyatake; Youichi Tatsumi; Takashi Ashida; Hirokazu Nakamine; Itaru Matsumura

doi:10.2169/internalmedicine.51.7457

CASE REPORTS

Sub-acute Demyelinating Polyradiculoneuropathy as an Initial Symptom of Peripheral T Cell Lymphoma, Not Otherwise Specified (PTCL-NOS)

Kazunobu Kawanishi, Yasuyo Ohyama, Yoshitake Kanai, Tikara Hirase, Hirokazu Tanaka, Junichi Miyatake, Youichi Tatsumi, Takashi Ashida, Hirokazu Nakamine, Itaru Matsumura

Author information

Kazunobu Kawanishi
Division of Hematology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kinki University, Japan
Yasuyo Ohyama
Division of Hematology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kinki University, Japan
Yoshitake Kanai
Division of Hematology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kinki University, Japan
Tikara Hirase
Division of Hematology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kinki University, Japan
Hirokazu Tanaka
Division of Hematology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kinki University, Japan
Junichi Miyatake
Division of Hematology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kinki University, Japan
Youichi Tatsumi
Division of Hematology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kinki University, Japan
Takashi Ashida
Division of Hematology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kinki University, Japan
Hirokazu Nakamine
Pathology and Immunology Division, Kansai University for Health Sciences, Japan
Itaru Matsumura
Division of Hematology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kinki University, Japan

Keywords: peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), demyelinating polyradiculoneuropathy, paraneoplastic peripheral neuropathy (PPN), CHOP chemotherapy

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 15 Pages 2015-2020

DOI https://doi.org/10.2169/internalmedicine.51.7457

Details

Abstract

Here we report the first case of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), who initially presented with peripheral neuropathy. Nerve conduction, cerebral spinal fluid studies and his clinical course were compatible with sub-acute demyelinating polyradiculoneuropathy. In addition, left cervical lymph node swelling was observed on admission. Diagnosis of PTCL-NOS was made by the histological, immunohistochemical, and Southern blot analyses on the biopsy specimen from the enlarged lymph node. Combination chemotherapy composed of cyclophosphamide, vincristine, doxorubicin and prednisolone (CHOP) was effective for polyneuropathy as well as for lymphoma. Several antibodies relating to paraneoplastic syndrome such as Ma1, Ma2, Amphiphysin, CV2, Ri, Yo and Hu were all negative. Because sural nerve biopsy performed prior to CHOP therapy revealed no infiltration of lymphoma cells, immune dysfunction mediated by some cytokine or unidentified autoantibody related to PTCL-NOS was thought to be involved in the polyradiculoneuropathy.

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