Pearls Oy-sters: Nonmotor Seizures as Presenting Feature of Hodgkin Lymphoma CNS Involvement

摘要

Pearls CNS involvement in Hodgkin lymphoma is extremely rare, and usually presents with focal weakness, nonspecific sensitive symptoms, headache, altered mental status, and seizures. Oy-sters CNS involvement usually presents during advanced stages, most commonly within the first 2 years after the initial diagnosis. CSF findings are nonspecific with low positivity rates on flow cytometry, which makes essential the need for tissue sampling. A 43-year-old woman hospitalized for acute bacterial cholangitis treated with piperacillin/ tazobactam and meropenem developed on day 10 of in-hospital stay an episode of abrupt headache followed by paresthesia of the right arm and a speech impairment lasting more than 15 minutes. Her medical history was relevant for a high-risk (international prognostic score of 4 points) stage IVB classical (mixed cellularity) Hodgkin lymphoma (HL) with lymphatic, gastrointestinal, hepatic, and bone marrow involvement diagnosed 4 months before admission. She was receiving treatment with AVDB (adriamycin, bleomycin, vinblastine, and dacarbazine) chemotherapy and had received the fourth cycle 1 month before admission.