AN UNUSUAL CASE OF MULTIPLE CRANIAL NERVES' PALSIES AND CONCOMITANT LUMBAR RADICULOPATHY AS THE FIRST PRESENTATION OF CNS-INFILTRATING LYMPHOMA.

Objective: To report a case of primary neurolymphomatosis with an unusual presentation as a combination of multiple cranial nerves’ palsies and lumbar radiculopathy. Background: Cranial nerve palsies can be due to multiple causes, the most common of which are metabolic and infectious ones. Although quite rare some cases are a result of direct infiltration by malignancies, such as lymphoma and should be considered in the differential diagnosis. Design/Methods: Case Report. Results: A 66 years-old male presented to an outside ER with peripheral facial palsy on the left side and was treated with a combination of Aciclovir and oral corticosteroid, with resolution of the symptoms. Twenty days later he had a new episode of right-sided peripheral facial palsy, with right abducens palsy, right-sided ptosis and an antalgic gait due to pain on the left leg suggestive of radicular compromise. This prompted his admission for investigation. CSF analysis revealed an elevated protein content, as well as pleocytosis with predominance of lymphocytes. PCR studies for viral agents and serologic tests were negative. Brain MRI disclosed an enlargement of the right III cranial nerve and of the VII bilaterally on the FLAIR sequence and lumbar MRI showed enlargement of L4 and L5 nerve roots on the left. A new course of IV corticosteroids and acyclovir had little improvement. A new CSF analysis disclosed the presence of 15% atypical cells, suggestive of oncological infiltration. Bone marrow biopsy showed infiltration and immunophenotyping revealed the cells to be of B-cell lineage, confirming the diagnosis of large B Cell lymphoma (CD20 + and a positive weak marker for BCL2 oncoprotein). Chemotherapy was promptly started with improvement of neurological symptoms. However, the patient died six months after the initial diagnosis. Conclusions: Our case broadens the clinical spectrum and illustrates the importance of early diagnosis and aggressive treatment of CNS infiltrating-lymphoma. Disclosure: Dr. Canever has nothing to disclose. Dr. Germiniani has nothing to disclose. Dr. Teive has nothing to disclose. Dr. Arruda has nothing to disclose. Dr. Almeida has nothing to disclose. Dr. Azambuja has nothing to disclose. Dr. Bertholdo has nothing to disclose. Dr. Almeida has nothing to disclose.