Guillain-Barre Syndrome and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Secretion as Paraneoplastic Syndromes in Splenic Marginal B-cell Non-Hodgkins Lymphoma: A Rare Presentation.

Madhuri Patil,Vijayadershan Muppidi,Sreenath Meegada,Joe D Bowers,Keanan T Dowell

doi:10.7759/cureus.10133

Abstract

Splenic marginal zone lymphoma (SMZL), a rare sub-type of non-Hodgkin lymphoma (NHL) presents with abdominal discomfort, lymphocytosis, cytopenias along with B symptoms including fatigue, night sweats, night fevers, weight loss. NHLs rarely present with paraneoplastic neurological syndromes like Guillain-Barre (GB) syndrome, myelopathy causing paraplegia, chorea, neuromyotonia, vasculitic neuropathy and dermatomyositis. Here, we present a 85-year old caucasian lady presenting with GB syndrome and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) who eventually got diagnosed with SMZL.

Highlights

Splenic marginal zone lymphoma (SMZL) is a subtype of Non-Hodgkin's lymphoma (NHL)
B symptoms and hyperviscosity syndromes are not common, presence of B symptoms especially with an elevated lactate dehydrogenase (LDH) should raise suspicion for transformation to diffuse large B cell lymphoma seen in about 10% of cases [3]
Urine studies were very suspicious for Syndrome of Inappropriate Antidiuretic Hormone (SIADH) and sodium levels improved with free water restriction

Summary

Introduction

Splenic marginal zone lymphoma (SMZL) is a subtype of Non-Hodgkin's lymphoma (NHL). Marginal zone lymphomas arise from B-lymphocytes and the name is derived due to its origin from the marginal zone of secondary lymphoid follicles [1]. She endorsed generalized weakness, body aches (most notably in her legs), and intermittent headache that had been persisting for about four weeks On presentation, her physical exam consisted of a blood pressure of 173/78 mmHg but otherwise normal vital signs, normal neurologic examination, and tenderness to palpation in the left lower quadrant. The patient received intravenous immune globulin (IVIG) for five days as well as supportive care with physical and occupational therapy for treatment of Guillain-Barré Syndrome Her strength improved and she was discharged to inpatient rehab with subsequent oncology follow up. She experienced B symptoms including fatigue, fever, and sweats She was later seen outpatient by oncology, bone marrow biopsy was performed, and she was diagnosed splenic marginal zone lymphoma. On follow up evaluation several months later and after several infusions of rituximab, she was noted to have complete resolution of these B symptoms and splenomegaly

Discussion

Conclusions

Disclosures

Findings

Zinzani PL