Positive Antiganglioside Antibodies in a Patient with Primary Diffuse Large B-cell Lymphoma of the Central Nervous System

Ryoji Nishi; Haruki Koike; Tomoya Maekawa; Yoshitaka Nakamura; Yohei Kawade; Takashi Tsujiuchi; Masasuke Ohno; Yuki Fukami; Masahisa Katsuno; Takafumi Sagisaka

doi:10.2169/internalmedicine.2326-23

Positive Antiganglioside Antibodies in a Patient with Primary Diffuse Large B-cell Lymphoma of the Central Nervous System

Intern Med. 2024 Nov 21. doi: 10.2169/internalmedicine.2326-23. Online ahead of print.

Authors

Ryoji Nishi^{1

2}, Haruki Koike³, Tomoya Maekawa¹, Yoshitaka Nakamura¹, Yohei Kawade¹, Takashi Tsujiuchi⁴, Masasuke Ohno⁵, Yuki Fukami⁶, Masahisa Katsuno^{6

7}, Takafumi Sagisaka¹

Affiliations

¹ Department of Neurology, Daido Hospital, Japan.
² Department of Neurology, Japan Community Health Care Organization Chukyo Hospital, Japan.
³ Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan.
⁴ Department of Neurosurgery, Daido Hospital, Japan.
⁵ Department of Neurosurgery, Aichi Cancer Center Hospital, Japan.
⁶ Department of Neurology, Nagoya University Graduate School of Medicine, Japan.
⁷ Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Japan.

PMID: 39566992
DOI: 10.2169/internalmedicine.2326-23

Abstract

Up to one-third of lymphoma cases involve the nervous system. Miller-Fisher syndrome (MFS) associated with lymphoma is extremely rare. We herein report a case of primary central nervous system lymphoma initially mimicking MFS in a 70-year-old man who presented with subacute unsteady gait and diplopia. A neurological examination revealed unilateral ophthalmoplegia, ataxia, and areflexia. The patient tested positive for anti-GQ1b antibodies, so MFS was initially suspected. However, the progression extended over one month. Subsequently, disturbance of consciousness was observed. Cranial magnetic resonance imaging revealed lesions in the periventricular fourth ventricle, and a brain biopsy indicated diffuse large B-cell lymphoma.

Keywords: Bickerstaff brainstem encephalitis; Miller-Fisher syndrome; anti-GQ1b antibody; anti-GQ1b syndrome; diffuse large B-cell lymphoma; primary central nervous system lymphoma.