Primary Leptomeningeal Lymphoma Presenting as Low Back Pain and Dementia: A Case Report
Clinical Neurology and Neuroscience
Volume 2, Issue 2, June 2018, Pages: 33-40
Received: May 31, 2018;
Accepted: Jul. 4, 2018;
Published: Jul. 30, 2018
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Vida Margarette de Vera Andal, Department of Neurosciences, University of the Philippines, Philippine General Hospital, Manila, Philippines
Julette Marie Feliciano Batara, Department of Neurosciences, University of the Philippines, Philippine General Hospital, Manila, Philippines
Joven Racpan Cuanang, St. Luke’s Medical Center Global City, Taguig, Philippines
Primary leptomeningeal lymphoma (PLL) is an extremely rare condition, with only a handful of cases reported in literature. Most often, these are misdiagnosed as other disease entities that are more commonly observed in practice. Currently, there are no clinical algorithms that may guide clinicians to clinching a diagnosis of PLL. This paper discusses a remarkable case of PLL presenting with atypical symptoms namely dementia and low back pain. This is a case of an apparently well adult male who initially presented with low back pain that was treated for two years as a case of lumbar disc herniation. This developed into lower extremity weakness and was subsequently followed by dementia and seizures. The patient was initially treated for tuberculous meningitis after CSF findings showed lymphocytic predominance. However, lack of clinical improvement prompted further work up revealing a malignant process in the lumbosacral meninges. Dural biopsy showed atypical mononuclear infiltrates consistent with a B-cell non-Hodgkin lymphoma with immunohistochemistry showing CD20 positive, CD79a positive, CD3 negative. Being MUM1 positive and BCL2 positive suggests it being a diffuse large B cell lymphoma. A primary malignancy of the leptomeninges was ruled in after PET CT showed no other sites of high metabolic activity. The patient was able to complete 6 cycles of high dose Methotrexate and three Rituximab doses. Remarkably, after more than two years after his initial presentation, he still has mild signs of dementia but is able to carry out most activities of daily living with minimal assistance. The patient has survived beyond the expected life expectancy for PLL.
Vida Margarette de Vera Andal,
Julette Marie Feliciano Batara,
Joven Racpan Cuanang,
Primary Leptomeningeal Lymphoma Presenting as Low Back Pain and Dementia: A Case Report, Clinical Neurology and Neuroscience.
Vol. 2, No. 2,
2018, pp. 33-40.
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