Department of Internal Medicine, American University of Beirut Medical Center, PO Box 113-6044, Beirut, Lebanon.
Int J Hematol. 2010 Apr;91(3):522-4. doi: 10.1007/s12185-010-0503-2. Epub 2010 Feb 9.
A patient was initially diagnosed with right basal ganglia lymphoma causing left hemiparesis. His disease was resistant to intravenous methotrexate, so he received radiation therapy with remarkable regression of the mass. However, 6 months after his initial diagnosis, he developed symmetric weakness of the proximal muscles. Electromyography was consistent with myasthenia gravis and anti-acetylcholine receptor antibodies were elevated. Treatment with pyridostigmine and corticosteroids improved his symptoms. The residual lymphoma was further treated with rituximab and temozolomide with complete resolution. Pyridostigmine and corticosteroids were stopped after 14 months of initiation with good results. Our case is the first case report of paraneoplastic myasthenia gravis developing in a patient with primary CNS lymphoma. The diagnosis of paraneoplastic myasthenia should be considered in patients with CNS lymphoma who develop muscle weakness and speech problems.
患者最初被诊断为右侧基底节淋巴瘤，导致左侧偏瘫。他的疾病对静脉注射甲氨蝶呤耐药，因此接受了放射治疗，肿块明显消退。然而，在最初诊断后的 6 个月，他出现了对称性的近端肌无力。肌电图检查符合重症肌无力，乙酰胆碱受体抗体升高。给予吡啶斯的明和皮质类固醇治疗后症状改善。残留的淋巴瘤进一步用利妥昔单抗和替莫唑胺治疗，完全缓解。起始治疗 14 个月后停用吡啶斯的明和皮质类固醇，效果良好。我们的病例是首例原发性中枢神经系统淋巴瘤患者发生副肿瘤性重症肌无力的病例报告。对于出现肌肉无力和言语问题的中枢神经系统淋巴瘤患者，应考虑副肿瘤性重症肌无力的诊断。
