Abstract
Introduction Neurological complications of haematological malignancies are commonly reported. However, they are less frequently the presenting complaint. Neurological presentations of haematological disease are often difficult to localise and signs are complicated by treatments to treat possible differential diagnoses (McKee & Li, 2022). The Neurologist needs to be aware of these when faced with the complex undifferentiated patient.
Case Summary This report documents the diagnostic dilemma of a 78 year old male presenting with an atypical history of painful diplopia, headache and recurrent intermittent episodes of acute, severe pain affecting all four limbs proximally. Past medical history was significant for ischaemic heart disease and previous prostate cancer cured with radical prostatectomy. Investigations showed mildly raised ESR at 45mm/hr and neutropaenia (Neutrophils: 0.6 x109). Prostate Specific Antigen (PSA) was < 0.01ug/L. Due to temporal headache, visual symptoms and pain, treatment for temporal arteritis was initiated with prednisolone 1mg/kg/day. Temporal artery biopsy was normal and subsequent radiological investigations revealed a pituitary mass, widespread sclerotic bone lesions, and diffuse bone marrow uptake on nuclear scintigraphy. With a normal PSA, haematological processes were considered. While initial comprehensive computerised tomography was normal, following steroid cessation FDG-PET demonstrated widespread subcutaneous lymphadenopathy. Bone marrow biopsy confirmed diffuse large B cell lymphoma.
Conclusion This case raises the difficulty in neurological presentations of haematological disease and illustrates the dichotomy of symptomatic treatment and diagnostic accuracy. While neurologists are experienced in therapeutics for known malignant disease atypical, difficult to localise symptoms should necessitate sufficient investigation and consideration of systemic disease.
Reference
McKee Z, Li Y. Unusual neurological presentations resulting in diagnosis of lymphoma in three patients. RRNMF Neuromuscular Journal, 2022;3(3):25–28, viewed 10 February 2023 https://journals.ku.edu/rrnmf/article/view/17930/16630
