Case report: From misdiagnosis to timely detection: a clinical and imaging guide to neurological presentations of diffuse large B-cell lymphoma—insights from six cases

TL;DR

This case report highlights how neurological symptoms of diffuse large B-cell lymphoma can lead to misdiagnosis, emphasizing the need for careful evaluation and timely detection.

Contribution

The paper provides a clinical and imaging guide to help neurologists recognize DLBCL in atypical neurological presentations.

Findings

DLBCL can present with neurological symptoms leading to misdiagnosis as cerebral infarction or encephalitis.

A median diagnostic delay of 8 months occurred due to overlapping symptoms with other neurological conditions.

Multimodal diagnostic approaches are crucial for accurate and timely diagnosis of DLBCL.

Abstract

The clinical spectrum of diffuse large B-cell lymphoma (DLBCL) is notably heterogeneous. Some DLBCL patients initially present with neurological manifestations, leading to their preliminary diagnosis within neurology departments. However, the overlap of clinical and auxiliary examination findings with those of various neurological entities—such as cerebral infarction, demyelination, viral encephalitis, and peripheral neuropathy—often results in diagnostic misattribution.

We delineate six pathologically-confirmed DLBCL cases, each heralded by neurological deficits, including limb paresis, sensory loss, vertigo, seizure activity, and aphasia. These presentations precipitated multiple erroneous diagnoses pertaining to nervous system pathologies, culminating in a median diagnostic latency of 8 months.

The differential diagnostic process for the misdiagnosed conditions in these cases has been meticulously revisited, enhancing the diagnostic acumen of neurologists. These cases underscore the imperative for neurologists to maintain a high index of suspicion for lymphoma in atypical presentations and to judiciously integrate multimodal diagnostic modalities—such as comprehensive imaging, cerebrospinal fluid analysis, and biopsy—to expedite diagnosis and initiate timely intervention.

Figures