Intravascular lymphomatosis presenting as an ascending cauda equina: conus medullaris syndrome: remission after biweekly CHOP therapy.

Abstract

A 63 year old man developed dysaesthesia in the legs followed by a subacute ascending flaccid paraparesis with sacral sensory and autonomic involvement. Intravascular lymphomatosis (IVL) was favoured by the presence of low grade fever and raised serum C reactive protein, CSF pleocytosis, raised lymphoma markers (serum LDH, soluble IL-2 receptor), and steroid responsiveness. Only muscle, among several organ biopsies, confirmed IVL. A cytogenetic study of the bone marrow showed chromosome 6 monosomy, as previously reported. The monosomy of chromosome 19, which bears the intercellular cell adhesion molecule-1, newly found in this case, may be related to the unique tumour embolisation of IVL. The CHOP regimen (six courses in 12 weeks) using granulocyte colony stimulating factor (G-CSF) led to gradual resolution of myeloradiculopathy and laboratory supported remission lasting for more than 13 months. The biweekly CHOP with G-CSF support may be a choice of chemotherapy in averting rapidly fatal IVL.

• Authors: T Nakahara, T Saito, A Muroi, Y Sugiura, M Ogata, Y Sugiyama, T Yamamoto
• Journal: Journal of neurology, neurosurgery, and psychiatry (J Neurol Neurosurg Psychiatry) Vol. 67 Issue 3 Pg. 403-6 (Sep 1999) ISSN: 0022-3050 [Print] England
• PMID: 10449569 (Publication Type: Case Reports, Journal Article)

Chemical References

• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cauda Equina (pathology)
• Cyclophosphamide (administration & dosage)
• Doxorubicin (administration & dosage)
• Humans
• Lymphoma, Large B-Cell, Diffuse (drug therapy, genetics, pathology)
• Male
• Middle Aged
• Muscles (pathology)
• Prednisone (administration & dosage)
• Vascular Neoplasms (drug therapy, genetics, pathology)
• Vincristine (administration & dosage)