Leptomeningeal metastasis in a marginal zone lymphoma, presenting as a delirium: case report

Autor: Bert Bravenboer, Kristin Jochmans, Tim Vanderhasselt, Ingo Beyer, Nicolas Maréchal, Michel Verheyden, Ann De Becker, Lisa Dreessen
Přispěvatelé: Geriatrics, Faculty of Medicine and Pharmacy, Dermatology, Hematology, Clinical Biology, Clinical sciences, Reproductive immunology and implantation, Medical Imaging, Radiology, Gerontology, Internal Medicine, Research in Geriatrics and Gerontology, Frailty in Ageing
Rok vydání: 2020
Předmět:
Zdroj: BMC Geriatrics, Vol 20, Iss 1, Pp 1-5 (2020)
BMC Geriatrics
ISSN: 1471-2318
DOI: 10.1186/s12877-020-01608-6
Popis: Background Hematologic malignancies can spread to the central nervous system (CNS), either as focal lesions or as leptomeningeal disease. Marginal zone lymphoma (MZL) is a low-grade non-Hodgkin lymphoma and generally presents as an indolent disease. This case report illustrates an unexpected diagnosis of leptomeningeal metastasis in an MZL, presenting as a delirium without B symptoms, pronounced hematologic progression or abnormalities on cerebral imaging. Case presentation An 80-year-old patient with a medical history of monoclonal B-cell lymphocytosis (MBL) with a clone indicative for an MZL, presented to the emergency and the geriatric departments with a recent cognitive deterioration and behavioral changes. MMSE score was 18/30. After excluding the most common etiologies through classical work-up including a normal head magnetic resonance imaging, a lumbar puncture was performed. In the cerebrospinal fluid an elevated protein level and increased lymphocyte count were identified, whereas beta-amyloid and tau protein levels were normal. Immunophenotyping of the lymphocytes confirmed CNS invasion by the MZL clone. Staging revealed mild splenomegaly. Prednisolone, intrathecal and systemic chemotherapy were initiated, leading to quick cognitive improvement with a final MMSE score of 28/30. Conclusions To the best of our knowledge a delirium in an older patient due to leptomeningeal disease in MZL has never been described. To date, rare reports of CNS invasion by MZL describe focal intracranial lesions. After exclusion of common etiologies, physicians should remain vigilant when confronted with a patient with history of MBL presenting neurological symptoms. This case illustrates the importance of low threshold for lumbar punctures in this population, also for those patients with normal imaging studies.
Databáze: OpenAIRE
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