Neurolymphomatosis or paraneoplastic syndrome? - #15982
Good morning, I will try to summarize my history for an opinion, even though I am aware of the limitations of distance. In the first week of August, I noticed a swollen, non-tender retroauricular lymph node (right ear). In September, I had an ultrasound which showed no suspicious features, and I was only told to repeat it if I noticed an increase in size. One night in mid-October, I woke up completely sweaty and shivering, and I realized I had a low-grade fever. This low-grade fever (max 37.7°C) lasted 2 days, but at night I started having strange tingling sensations in my legs that kept me from sleeping, and on the fourth day from the onset of the fever, I felt a searing burn in my right leg for several hours. From that moment until now, over a month later, my right leg is constantly weak, numb, sometimes with burning/pain extending to the sole of the foot, and my left arm is also weak and lacks strength (to a lesser extent than the leg). The night sweats continued intermittently for 2 weeks and have now disappeared. Over the course of this month, I underwent: 2 further ultrasounds of the lymph node stations which showed reactive lymph nodes with no suspicious characteristics. CT scan of the neck, chest, and abdomen without contrast: Reported small reactive lymph node nodules. The mediastinum showed some subcentimetric, reactive-looking lymph node nodules. Some reactive lymph node nodules in the lomboaortic area and a greater number in the inguinal area, non-liquefied and non-confluent. Blood tests (all normal): Complete blood count with smear, LDH, Beta-2 microglobulin, iron and ferritin levels, ESR, CRP, protein electrophoresis, Bence Jones protein in the serum, complete urine test, ANA, and rheumatoid factor. Serology: Positive EBV IgG, negative EBV IgM; Anti-Herpes positive IgG only; Cytomegalovirus and Toxoplasmosis all negative. Electromyography (EMG): Performed 2 weeks after the onset of symptoms, negative. MRI without contrast of the brainstem and spinal cord: All normal except for "Verticalization of the physiological cervical lordosis," "Diffuse protrusion of the posterior disc margin of L4/L5 with impression on the dural sac," and "Slight posterior median and bilateral paramedian protrusion at L5/S1 impressing the dural cul-de-sac." I had two hematological consultations where, in light of the performed tests, I was told there is no trace of lymphoproliferative disease. The neurologist, after prescribing the EMG and MRI without contrast, advised me to see an orthopedist. Unfortunately, however, my arm and leg symptoms have been constant for over a month now. I have read in scientific articles that lymphoma can, in rare cases, present with symptoms very compatible with mine, by infiltrating the nerves or due to a paraneoplastic syndrome. I am very worried and hope for your kind feedback. Thank you in advance.
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Doctors’ responses
Hello dear See as per clinical history the tests are not in support of either paraneoplastic syndrome or lymphoma or cancer However if you are having doubt get following tests done and share with neurologist/orthopedic surgeon Lems or anti-achr Anti-ma2 Pet scan Gaba-b Mri / ct scan Emg Muscle biopsy Please share the result with orthopedic surgeon or neurologist for better clarity Also, In addition please share clinical pic for confirmation Regards
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