Intravascular lymphomatosis presenting as an ascending cauda equina: conus medullaris syndrome: remission after biweekly CHOP therapy

摘要

A 63 year old man developed dysaesthesia in the legs followedby a subacute ascending flaccid paraparesis with sacral sensory andautonomic involvement. Intravascular lymphomatosis (IVL) was favouredby the presence of low grade fever and raised serum C reactive protein,CSF pleocytosis, raised lymphoma markers (serum LDH, soluble IL-2receptor), and steroid responsiveness. Only muscle, among several organbiopsies, confirmed IVL. A cytogenetic study of the bone marrow showedchromosome 6 monosomy, as previously reported. The monosomy ofchromosome 19, which bears the intercellular cell adhesion molecule-1,newly found in this case, may be related to the unique tumourembolisation of IVL. The CHOP regimen (six courses in 12 weeks) usinggranulocyte colony stimulating factor (G-CSF) led to gradual resolutionof myeloradiculopathy and laboratory supported remission lasting formore than 13 months. The biweekly CHOP with G-CSF support may be achoice of chemotherapy in averting rapidly fatal IVL.