Hodgkin's Lymphoma Presenting With Peripheral Neuropathy

Introduction/Background/Significance: Lymphoma-associated paraneoplastic neuropathy is uncommon, accounting only 6.4% of cases. The central and peripheral nervous systems may be affected, with involvement of the peripheral nervous system more common in Non-Hodgkin's Lymphoma than Hodgkin's Lymphoma. Paraneoplastic syndrome, in general, is a diagnosis of exclusion hence extensive work-ups to rule out other possible causes must be done before a diagnosis of such is made as in this case of an adult male presenting with bilateral upper and lower extremity numbness.

Materials and Methods/Case Presentation/Objective: A 56-year-old male, diabetic, presented with intermittent paresthesia of the bilateral lower extremities initially managed as diabetic neuropathy. Medications provided temporary relief, leading to EMG-NCV and laboratory tests with normal findings. Due to progression of paresthesia, now with associated numbness (50% deficit from C5 down) and weakness of bilateral upper and lower extremities (4/5 bilateral upper extremities, 3-4/5 bilateral lower extremities), Guillain-Barré syndrome was entertained, however lumbar puncture was unremarkable. A whole spinal MRI was done due to further progression of symptoms, which revealed multiple, enlarged, and confluent lymph nodes in the supraclavicular, upper and lower paratracheal, paraaortic regions with the largest confluence measuring 6.1 x 3.0 x 3.0 cm in the paraaortic region. A neoplastic process was considered; hence a PET CT scan was requested revealing extensive FDG-avid lymph nodes in the jugular, supraclavicular regions, chest and abdomen. Biopsy of the supraclavicular lymph node was performed, confirming a diagnosis of Classical Hodgkin's Lymphoma, Nodular Sclerosis, Stage III. Treatment regimen consisting of brentuximab vedotin, plus doxorubicin, vinblastine, and dacarbazine (A+AVD) was started with noted improvement of motor deficit after the 4th cycle of chemotherapy.

Conclusions: Paraneoplastic neurologic syndrome is rare especially among patients with Hodgkin's Lymphoma. Further studies are required to better understand the efficacy of treatment among Hodgkin's Lymphoma patients inflicted with paraneoplastic neurologic syndrome, however A+AVD is a promising treatment in terms of overall survival and improvement of neurologic symptoms.