Neuroimaging insights into poor prognosis paraneoplastic encephalomyelitis: A case report on a challenging diagnosis revealed by MR imaging in a patient with Hodgkin's lymphoma

Abderrahmane Ibenyahia, MD; Said Adnor, MD; Soufiane Bigi, MD; Imane Bazi, MD; Adel Elmekkaoui, MD; Benlenda Othmane, MD; Nassik Hicham, MD; Soukaina Wakrim, MD

Radiology Case Reports (Nov 2024)

Neuroimaging insights into poor prognosis paraneoplastic encephalomyelitis: A case report on a challenging diagnosis revealed by MR imaging in a patient with Hodgkin's lymphoma

Abderrahmane Ibenyahia, MD,
Said Adnor, MD,
Soufiane Bigi, MD,
Imane Bazi, MD,
Adel Elmekkaoui, MD,
Benlenda Othmane, MD,
Nassik Hicham, MD,
Soukaina Wakrim, MD

Affiliations

Abderrahmane Ibenyahia, MD: Radiology Department, Faculty of Medicine and Pharmacy, University Hospital Center of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco; Corresponding author.
Said Adnor, MD: Radiology Department, Faculty of Medicine and Pharmacy, University Hospital Center of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco
Soufiane Bigi, MD: Radiology Department, Faculty of Medicine and Pharmacy, University Hospital Center of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco
Imane Bazi, MD: Radiology Department, Faculty of Medicine and Pharmacy, University Hospital Center of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco
Adel Elmekkaoui, MD: Department of Anesthesia Reanimation, Faculty of Medicine and Pharmacy, University Hospital Center of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco
Benlenda Othmane, MD: Department of Anesthesia Reanimation, Faculty of Medicine and Pharmacy, University Hospital Center of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco
Nassik Hicham, MD: Department of Anesthesia Reanimation, Faculty of Medicine and Pharmacy, University Hospital Center of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco
Soukaina Wakrim, MD: Radiology Department, Faculty of Medicine and Pharmacy, University Hospital Center of Souss Massa, Ibn Zohr Agadir University, Agadir, Morocco

Journal volume & issue: Vol. 19, no. 11
pp. 4992 – 4999

Abstract

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Paraneoplastic encephalomyelitis (PEM) is a rare complication associated with malignancies, often presenting before the cancer diagnosis. A 42-year-old male with a history of chronic smoking presented with acute urinary retention and neurological deficits, all evolving in a febrile context with general deterioration. Laboratory tests were conducted, followed by a cerebral MRI which revealed multiple T2 and FLAIR hyperintense lesions in the periventricular and periaqueductal regions, medial temporal lobes, and bilateral postero-medial thalamus. Enhanced CT scans of the chest and abdomen identified multiple cervical, axillary, and inguinal lymphadenopathies. Subsequently, an ultrasound-guided biopsy of a cervical node was performed. His condition deteriorated rapidly, requiring intubation and sedation. A subsequent MRI revealed worsening cerebral and spinal cord lesions with new contrast enhancement in the brainstem. The differential diagnosis included toxic/metabolic and paraneoplastic causes. Biopsy results confirmed Hodgkin's lymphoma, leading to a diagnosis of progressive paraneoplastic encephalomyelitis (PEM). Despite adequate treatment, the patient's condition worsened, leading to death from pneumonitis and metabolic complications. This case underscores the importance of considering PEM in patients with neurological deficits and malignancy, with MRI playing a crucial role in diagnosis. Early detection and treatment are essential to improving outcomes.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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