Lymphomatous polyneuropathy. Biopsy of clinically involved nerve and successful treatment
D. A. Krendel, R. L. Stahl and W. C. Chan
Department of Neurology, Emory University School of Medicine, Atlanta, GA.
We present a patient with large-cell lymphoma in remission who, over
several weeks, developed widespread multifocal polyneuropathy. There was
involvement of all four limbs, most severely the left upper extremity that
had become useless. Biopsy of the left saphenous nerve within an area of
sensory loss showed lymphoma in the endoneurium. There was no other
evidence of recurrent lymphoma despite extensive investigation, including
bone marrow, lumbar puncture, magnetic resonance imaging of the spine, and
computed tomography of the abdomen and pelvis. Intensive systemic
chemotherapy was accompanied by nearly complete recovery. Biopsy of a
symptomatic nerve is preferable to routine sural nerve biopsy in this
condition because of its patchy distribution. Treatment with systematic
chemotherapy can be effective.
