Rapid Neurologic Decline in a Patient With Peripheral T-Cell Lymphoma: A Case of Leptomeningeal Lymphomatosis

Abstract

Case and Introduction A 62-year-old African American man presented to the emergency department with subacute onset of abdominal distention, massive ascites, and shortness of breath. He had no B-symptoms and no neurologic symptoms or deficits. Results of a paracentesis and cytologic examination revealed innumerable large cells with round, oval, or irregularly shaped nuclei with moderate amounts of dark blue cytoplasm. Flow cytometry confirmed a malignant population of CD2 , CD3 , CD5 and T-cell receptor (TCR)-alpha/beta posiive cells with a virtual absence of other lymphocytes. Molecular nalysis confirmed a clonal T-cell population. There was an absence f anaplastic lymphoma kinase protein on immunohistochemistry. n situ hybridization for Epstein-Barr virus related RNA did not emonstrate hybridization signals. Staging evaluation with comuted tomography (CT) revealed diffuse adenopathy with a large ight pleural effusion. Staging positron emission tomography (PET) emonstrate fluorine-18 fluorodeoxyglucose (FDG) avid lymph odes in the chest, abdomen, and pelvis; diffuse peritoneal FDG vidity; and a mild-to-moderate FDG avidity in the humeral head, hich corresponded to a lucent lesion noted on CT. A bone marrow iopsy and aspirate was relatively normal, with only a 1% immuno-