Autoantibody-Mediated Sensory Polyneuropathy Associated with Indolent B-Cell Non-Hodgkin’s Lymphoma: A Report of Two Cases
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Background and Purpose Abnormalities of the peripheral nervous system occur in 5% of patients with lymphoma. Polyneuropathy has not been described in patients with mantlecell and marginal-zone B-cell lymphomas. Case Report Two elderly patients with indolent non-Hodgkin’s lymphoma developed a progressive sensory polyneuropathy that was associated with serum autoantibodies directed against asialosyl/sialosyl gangliosides and myelin-associated glycoprotein/sulfated glucuronyl paragloboside, respectively, which are peripheral-nerve antigens. Te oligoclonal pattern of these antibodies hinted at a lymphoma-induced immune dysregulation. Te neuropathy stabilized clinically during treatment with intravenous immunoglobulin G. B-cell lymphoma was managed with a “watchful waiting” approach. Conclusions Te concept of antigen-specifc, immune-mediated neuropathy associated with slow-growing lymphoma of mature B-cells may be underrecognized. Te principle of treating the illness underlying neuropathy may not be always indicated or necessary if risk-beneft and cost-beneft analyses are taken into account.
Abstract
Background and Purpose Abnormalities of the peripheral nervous system occur in 5% of patients with lymphoma. Polyneuropathy has not been described in patients with mantlecell and marginal-zone B-cell lymphomas. Case Report Two elderly patients with indolent non-Hodgkin’s lymphoma developed a progressive sensory polyneuropathy that was associated with serum autoantibodies directed against asialosyl/sialosyl gangliosides and myelin-associated glycoprotein/sulfated glucuronyl paragloboside, respectively, which are peripheral-nerve antigens. Te oligoclonal pattern of these antibodies hinted at a lymphoma-induced immune dysregulation. Te neuropathy stabilized clinically during treatment with intravenous immunoglobulin G. B-cell lymphoma was managed with a “watchful waiting” approach. Conclusions Te concept of antigen-specifc, immune-mediated neuropathy associated with slow-growing lymphoma of mature B-cells may be underrecognized. Te principle of treating the illness underlying neuropathy may not be always indicated or necessary if risk-beneft and cost-beneft analyses are taken into account.
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