Treatment Decisions in a Man With Hodgkin Lymphoma and Guillian-Barré Syndrome: A Case Report

Caren L Hughes; Jeffrey T Yorio; Craig Kovitz; Yasuhiro Oki

Disclosures

J Med Case Reports. 2014;8(455) 

In This Article

Abstract and Introduction

Abstract

Introduction Guillain-Barre syndrome, or acute inflammatory demyelinating polyneuropathy, has been described in the presence of malignancies such as lymphoma. Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy causes paresthesias and weakness, which can make the treatment of lymphoma with chemotherapy challenging. Given the rarity of this co-presentation it is not known if the effects of Guillain-Barre syndrome should be considered when selecting a treatment regimen for Hodgkin lymphoma. To the best of our knowledge, the impact of these treatment modifications has not been previously reported.

Case presentation We report the case of a 37-year-old Caucasian man with a diagnosis of stage IIB classical Hodgkin lymphoma with concomitant Guillain-Barre syndrome. Our patient originally presented with an enlarged cervical lymph node and quickly developed distal paresthesia and progressive weakness of all four extremities. He was diagnosed with Hodgkin's lymphoma and initiated on treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine. Doses of bleomycin and vinblastine were held or dose-reduced throughout his initial treatment course due to underlying neuropathy and dyspnea. He continued to have persistent disease after five cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and went on to receive salvage treatments including more chemotherapy, radiation, autologous stem cell transplant and is currently preparing for an allogeneic stem cell transplant.

Conclusions Paraneoplastic syndromes such as Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy can make the treatment of patients with Hodgkin lymphoma more challenging and can interfere with delivering full-dose chemotherapy. Further case series are needed to evaluate the effect that paraneoplastic syndromes, or adjustments made in therapy due to these syndromes, negatively affect the prognosis of patients with Hodgkin lymphoma.

Introduction

Paraneoplastic syndromes can develop in patients with cancer and indicate damage to distant organs or tissues via mechanisms external to the cancer itself.[1,2] They are seen in less than 1% of patients with malignancies and cause a variety of disorders, including hematologic, dermatologic, renal and neurologic abnormalities.[1,2] Guillain-Barré syndrome (GBS), or acute inflammatory demyelinating polyneuropathy (AIDP), is characterized by distal paresthesia and progressive bilateral, symmetric weakness of the extremities.[3] It is often precipitated by underlying infection, but has also been well described in the presence of malignancies, particularly lymphomas.[4–10] Since these associations are rare with only case reports in the literature, it is not truly known if the presence of paraneoplastic syndromes, such as GBS, should be considered when determining treatment intensity, or if the co-presence of these syndromes affects the prognosis of patients with underlying lymphoma. We describe the treatment and course of disease in a young man with Hodgkin lymphoma (HL) with associated GBS.

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