Paraneoplastic polyneuropathy preceding the diagnosis of Hodgkin's disease and non-small cell lung cancer in a patient with concomitant Borrelia burgdorferi infection

• Published in: Annals of hematology 2001-04, Vol.80 (4), p.232-235
• Main Authors: BEHRINGER, D, SPYRIDONIDIS, A, FETSCHER, S, SCHMITT-GRÄFF, A, HÖGERLE, S, KAISER, R
• Format: Article
• Language: English
• Subjects: Adult; Antibiotics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Biopsy; Borrelia burgdorferi; Borreliosis; Carcinoma, Non-Small-Cell Lung - complications; Carcinoma, Non-Small-Cell Lung - diagnosis; Ceftriaxone - therapeutic use; Cerebrospinal fluid; Electrophysiology; Hematologic and hematopoietic diseases; Hodgkin Disease - complications; Hodgkin Disease - diagnosis; Hodgkin Disease - therapy; Hodgkin's disease; Humans; Immunoglobulin G; Infection; Inflammation; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - diagnosis; Lung Neoplasms - surgery; Lyme Disease - complications; Lyme Disease - diagnosis; Lyme Disease - drug therapy; Male; Malignancy; Medical sciences; Nerves; Neuritis; Non-small cell lung carcinoma; Paraneoplastic Polyneuropathy - complications; Paraneoplastic Polyneuropathy - diagnosis; paraneoplastic syndrome; Peripheral neuropathy; Pneumology; Polyneuropathy; Radiation; Radiotherapy; Remission; Remission Induction; sural nerve; Sural Nerve - pathology; Tomography, X-Ray Computed; Tumors of the respiratory system and mediastinum
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s002770000267

A patient with painful peripheral neuropathy is presented, whose symptoms were thought to result from an infection with Borrelia burgdorferi sensu lato. Investigations of the cerebrospinal fluid for signs of inflammation and borrelial antibodies were negative, and the patient did not benefit from repeated antibiotic treatment. Electrophysiologic studies and sural nerve biopsy showed axonal neuropathy consistent with a paraneoplastic syndrome. Further workup revealed mediastinal Hodgkin's disease (HD; nodular sclerosing subtype) Ann Arbor stage II and non-small cell cancer of the lung (stage T1N0M0). Surgical resection of the lung cancer and combined chemo- and radiotherapy for HD resulted in complete remission of both malignancies. While the preexisting neurologic symptoms persisted during treatment, neurography showed some improvement of the distal nerves. During radiation therapy the patient developed transient left-sided brachial plexopathy. This case illustrates that the diagnosis of borreliosis in patients with isolated painful peripheral neuritis cannot be based solely upon positive IgG titers and supports the requirement for a thorough workup for an underlying--potentially curable--disease. In addition, singular pulmonary lesions in the setting of HD should be suspected to have a separate cause.