Disseminazione intratecale di meningoradicolite linfomatosa: Descrizione di un caso clinico

We report the case of a 27-year-male who developed a rapidly progressive involvement of multiple cranial nerves together with signs/symptoms of widespread radicular disease at all spinal cord levels; search for infectious, inflammatory and autoimmune disorders was negative, as well as screening for occult tumor in non-CNS sites (including bone marrow biopsy). Cerebrospinal fluid analysis - initially disclosing mild lymphocytic pleocytosis - allowed diagnosis after steroid withdrawal (2 months from onset), showing 1600 cells/mm3, low glucose and presence of monoclonal B-lymphocytic expansion limited to the CSF. Despite high-dose methotrexate therapy and 1 cycle of Ara-C, the patients' conditions progressively deteriorated leading to the exitus. This case shows the peculiarity of a lymphoproliferative disorder with an intrathecal localization and only a negligible involvement of PB (increase in percentage of CD20 and CD19 positive cells).