LOW-GRADE NON-HODGKIN B-CELL LYMPHOMA PRESENTING AS SENSORY NEUROPATHY

Low-grade non-Hodgkin B-cell lymphoma was found during the evaluation of 3 aged patients with predominantly sensory neuropathy of mild to mo derate severity. Presenting manifestations were sensory ataxia and rig ht ulnar mononeuropathy in a 75-year-old man, and painful dysesthesias of the legs in two 78-year-old women. A neurophysiological study show ed mainly axonopathic alterations. M-protein was present in all cases (Ig-kappa in two, triclonal gammopathy IgG(kappa)/IgM(kappa)/IgM-lambd a in one). The male patient had IgM antisulfatide antibody in high tit er, whereas the other 2 patients had cryoglobulinemia (type II and typ e III, respectively). Our report emphasizes the occurrence of mild pol yneuropathy as presenting manifestation of low-grade non-Hodgkin lymph oma, different from the clinicopathological entity of neurolymphomatos is, in which severe nerve damage occurs in association with manifest l ymphoma, related to nerve infiltration by lymphomatous cells. Alternat ive pathogenetic mechanisms, such as antibody-mediated nerve damage, o r vasa nervorum changes caused by cryoglobulin, may be implicated in o ur cases. Non-Hodgkin lymphoma should be considered in the diagnostic evaluation of polyneuropathy of unknown cause, especially in patients with paraproteinemia and/or cryoglobulinemia.