Diagnosis and Treatment of Low-Grade Marginal Zone B-cell Lymphoma With Psychiatric Overlap

TL;DR

An elderly man with low-grade lymphoma and severe psychiatric symptoms was successfully treated with a combination of electroconvulsive therapy and rituximab.

Contribution

Highlights the importance of considering oncological causes in psychiatric presentations and the efficacy of ECT in such cases.

Findings

Psychiatric symptoms can obscure underlying lymphoma, delaying diagnosis.

ECT rapidly improved catatonia, enabling clearer identification of the oncological condition.

Rituximab treatment was effective for the lymphoma.

Abstract

This case report delineates the intricate interplay between psychiatric and oncological pathology in a 72-year-old male diagnosed with low-grade marginal zone B-cell lymphoma and severe psychiatric disturbances, including catatonia. The presentation of severe psychiatric symptoms initially obscured the underlying lymphoma, delaying diagnosis and complicating clinical management. Notably, the lymphoma itself may have precipitated or exacerbated the psychiatric condition, underscoring the potential for oncological diseases to manifest with rapidly progressive dementia and catatonia. A multidisciplinary approach was employed, utilizing electroconvulsive therapy (ECT) for rapid resolution of catatonia, which facilitated significant mental health improvements and clearer delineation of the oncological underpinnings. Concurrently, the patient was treated with rituximab, targeting the lymphoma. This case highlights the critical need for a comprehensive evaluation in patients presenting with psychiatric symptoms, particularly in the elderly, to uncover potential medical causes and illustrates the efficacy of ECT in managing psychiatric conditions that may overshadow or complicate concurrent medical issues.

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