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Fatal peripheral neurolymphomatosis after remission of histiocytic lymphoma

Departments of Internal Medicine "D," (Drs. Shoenfeld, Aderka, Santo, and Pinkhas) Pathology (Dr. Sandbank) and Neurology, (Dr. Gadot) the Sackler School of Medicine, Tel Aviv University, Beilinson Medical Center, Petah Tikva, Israel.

A 32-year-old woman with histiocytic lymphoma was in complete clinical remission after two courses of chemotherapy, when peripheral neuropathy developed fulminantly. Abnormalities included facial nerve paralysis, dysphagia, quadriparesis, myalgia, and incontinence. She died 10 days after onset of these symptoms. Postmortem examination revealed infiltration of peripheral nerves by lymphomatous cells with no involvement of meninges, brain, lymph nodes, or other organs. Differences in the blood-brain barrier of peripheral and central nervous system are suggested: The peripheral barrier may be more penetrable by malignant histiocytes or less permeable to cytotoxic drugs. Intrathecal chemotherapeutic drug instillation and irradiation may be beneficial.

Address reprint requests to Dr. Shoenfeld, Department of Internal Medicine "D," Beilinson Medical Center, Petah Tikva 49100, Israel.

Address correspondence to Dr. Shoenfeld, Cancer Research Center, 136 Harrison Ave., Boston, MA 02111.

Accepted for publication June 24, 1982.

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