Guillain-Barré syndrome and hemophagocytic syndrome heralding the diagnosis of diffuse large B cell lymphoma: A case report

doi:10.12998/wjcc.v10.i26.9502

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Sep 16, 2022; 10(26): 9502-9509
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9502

Guillain-Barré syndrome and hemophagocytic syndrome heralding the diagnosis of diffuse large B cell lymphoma: A case report

Qiao-Lin Zhou, Zhao-Kun Li, Fang Xu, Xiao-Gong Liang, Xing-Biao Wang, Jing Su, Yu-Feng Tang

Qiao-Lin Zhou, Fang Xu, Xiao-Gong Liang, Jing Su, Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China

Zhao-Kun Li, Yu-Feng Tang, Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China

Xing-Biao Wang, Department of General Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China

Author contributions: Zhou QL and Xu F contributed to manuscript writing and editing, and data collection; Li ZK contributed to data analysis; Liang XG, Wang XB, Su J and Tang YF contributed to conceptualization and supervision; all authors have read and approved the final manuscript.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Fang Xu, MD, Academic Fellow, Chief Doctor, Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12 Changjia Alley, Jingzhong Street, Fucheng District, Mianyang 621000, Sichuan Province, China. 147377807@qq.com

Received: May 11, 2022
Peer-review started: May 11, 2022
First decision: June 16, 2022
Revised: June 26, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: September 16, 2022
Processing time: 100 Days and 14.4 Hours

Abstract

BACKGROUND

Central nervous system (CNS) lesions and peripheral neuropathy are rare among patients with non-Hodgkin's lymphoma (NHL). Lymphomatous infiltration or local oppression usually accounts for CNS or peripheral nerve lesions. The incidence of peripheral neuropathy was 5%. Guillain-Barré syndrome (GBS) is rare and may occur in less than 0.3% of patients with NHL. Hemophagocytic syndrome (HPS) is a rare complication of NHL. It has been reported that 1% of patients with hematological malignancies develop HPS. Diffuse large B-cell lymphoma (DLBCL) combined with GBS has been reported in 10 cases.

CASE SUMMARY

We report the case of a 53-year-old man who was initially hospitalized because of abnormal feelings in the lower limbs and urinary incontinence. He was finally diagnosed with DLBCL combined with GBS and HPS after 16 d, which was earlier than previously reported. Immunoglobulin pulse therapy, dexamethasone, and etoposide were immediately administered. The neurological symptoms did not improve, but cytopenia was relieved. However, GBS-related clinical symptoms were relieved partially after one cycle of rituximab - cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (R-CHOP) chemotherapy and disappeared after six cycles of R-CHOP.

CONCLUSION

GBS and HPS heralding the diagnosis of Epstein-Barr virus DLBCL are rare. Herein, we report a rare case of DLBCL combined with GBS and HPS, and share our clinical experience. Traditional therapies may be effective if GBS occurs before lymphoma is diagnosed. Rapid diagnosis and treatment of DLBCL are crucial.

Keywords: Diffuse large B cell lymphoma; Guillain-Barré syndrome; Hemophagocytic syndrome; Peripheral neuropathy; Case report

Core Tip: Guillain-Barré syndrome (GBS) is uncommon in diffuse large B-cell lymphoma (DLBCL). GBS and hemophagocytic syndrome (HPS) heralding the diagnosis of Epstein-Barr virus DLBCL are clinically rare. Herein, we report a rare case of DLBCL complicated with GBS and HPS. We also analyze the reported cases extracted in PubMed in terms of all the possible etiologies of GBS. Traditional therapies may be ineffective in patients who develop GBS before lymphoma is diagnosed. Rapid diagnosis and treatment of DLBCL are crucial.