Diabetes insipidus in a patient with a highly malignant B-cell lymphoma and stomatitis

A 37-year-old male patient with a diffuse pleomorphic B-cell-lymphoma, whic h has been diagnosed two month earlier with the primary site at the pterygo palatine fossa on both sides with infiltration of the clivus and cavernous sinus was referred to our hospital for continuation of the third course of CHOP chemotherapy At admission he reported about a recent history of painful swallowing and i ntermittent substernal chest pain. Alleviation of the pain on swallowing an d the chest pain was apparently only possible by drinking 10 to 151 of cold coca cola throughout the day and night, a regimen that resulted in polyuri a. Physical examination revealed extensive thrush stomatitis and soor esoph agitis. Despite successful treatment with fluconazole, polydipsia continued unabated. The classic osmotic test of dehydration and exogenous vasopressi n revealed hypothalamic diabetes insipidus (DI). Basal hormones and stimula ted endocrine function tests of the adenohypophysis were found to be normal . MRI-scan revealed lymphoma infiltration of the neurohypophysis. After the third course of CHOP chemotherapy the patient surprisingly recovered compl etely from his excessive thirst. The present report shows that clinical disorders such as thrush stomatitis can mask diabetes insipidus caused by an early relapsing lymphoma.