A Case of Paraneoplastic Cerebellar Degeneration that Preceded the Diagnosis of Classical Hodgkin’s Lymphoma by 16 Months
Unknown etiology, Challenging differential diagnosis
Nerea Arratibel, Eduardo Sobejano, Jose Carlos Moran, Luis G. Diaz, Almudena Blázquez, Mónica Baile, Álvaro Veiga, Maria Dolores Caballero, Ramón García-Sanz
Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
Am J Case Rep 2020; 21:e922342
Available online: 2020-04-20
Paraneoplastic cerebellar degeneration (PCD) is a rare condition that can present as an acute or subacute cerebellar syndrome. PCD is most commonly associated with gynecological and breast cancer, small-cell lung cancer, and classical Hodgkin’s lymphoma. The symptoms of PCD can arise several months before tumor diagnosis. This report is of a case of a 44-year-old man with PCD that preceded the diagnosis of classical Hodgkin’s lymphoma by 16 months.
CASE REPORT: A 44-year-old man was admitted to hospital with a cerebellar syndrome that was initially diagnosed as vertebrobasilar insufficiency. Eight months later, cerebral magnetic resonance imaging (MRI) findings and serum anti-Tr antibodies supported the diagnosis of PCD, but no underlying malignancy was initially found. At 16 months after the initial diagnosis of PCD, the patient developed an enlarged inguinal lymph node. Histology of the excisional lymph node biopsy confirmed the diagnosis of classic mixed cellularity Hodgkin’s lymphoma, Ann Arbor stage IIA. The patient responded to four cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy.
CONCLUSIONS: This case illustrates that in patients who present with PCD, an associated malignancy, such as classical Hodgkin’s lymphoma, may emerge several months later, which supports long-term follow-up. The presence of anti-Tr antibodies may support a diagnosis of classical Hodgkin’s lymphoma in a patient with a history of PCD who develops lymphadenopathy.
Keywords: Hodgkin Disease, Neurologic Manifestations, Paraneoplastic Cerebellar Degeneration