Goron Abby R, Devlin Stephen, Schwartz Stacy
University of Maryland School of Medicine, Baltimore, Maryland, USA.
Internal Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA.
BMJ Case Rep. 2019 Jul 19;12(7):e229988. doi: 10.1136/bcr-2019-229988.
A 58-year-old man with a history of rheumatoid arthritis and stage IV diffuse large B-cell lymphoma, in complete remission with no evidence of residual disease on positron emission tomography/CT after completing six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy, presented with acute onset of dysphagia to solids and liquids. On further evaluation, his dysphagia was attributed to a vagus nerve palsy, and later during his admission, he developed rapidly progressing left facial and vestibulocochlear nerve palsies. Imaging studies displayed pathological enhancement of bilateral seventh and eighth cranial nerves, concerning for leptomeningeal recurrence of lymphoma. Cerebrospinal fluid analysis and flow cytometry were confirmatory, revealing markedly atypical monotypic CD19 positive B cells.
一名58岁男性，有类风湿关节炎病史，曾患IV期弥漫性大B细胞淋巴瘤，在完成六个周期的利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松化疗后，正电子发射断层扫描/计算机断层扫描显示完全缓解，无残留疾病迹象。现出现急性吞咽固体和液体困难。进一步评估发现，其吞咽困难归因于迷走神经麻痹，入院后不久，他又迅速出现左侧面神经和前庭蜗神经麻痹。影像学检查显示双侧第七和第八颅神经病理性强化，怀疑为淋巴瘤软脑膜复发。脑脊液分析和流式细胞术得到确诊，发现明显非典型的单型CD19阳性B细胞。
