Guillain-Barré Syndrome as the Initial Clinical Manifestation of Hodgkin's Lymphoma.

Background: There are a considerable number of published cases reporting the clinical development of neurological symptoms in people diagnosed with Hodgkin's lymphoma (HL). However, Guillain-Barré syndrome (GBS) as the initial clinical manifestation of HL is extremely rare. We describe a complex case of GBS with the subsequent diagnosis approach leading to the diagnosis of HL. Case report: A 32-year-old male presented to the emergency department due to paraesthesia of the upper and lower extremities and muscle weakness of the lower extremities that began 1 week earlier, and diplopia observed during last 24 hours. The neurological examination revealed paresis of the left abductor nerve, moderate paraparesis, stocking-glove hypoesthesia, absence of tendon reflexes in the lower extremities, disturbance of deep sensory, sensory ataxia, dysesthesias and neuropathic pain of extremities. The lumbar puncture revealed albuminocytologic dissociation in cerebrospinal fluid. In the electrophysiological examination mainly motor demyelinating polyradiculoneuritis was reported. These findings supported the diagnosis of GBS and intravenous immunoglobulin (2 g/kg) was administered over 5 days. However, the patient deteriorated and developed more severe neurological symptoms including paresis of left peripheral facial nerve, right abductor nerve, oculomotor nerve bilaterally and severe tetraparesis. The patient had seven sessions of plasmapheresis with partial resolution of the neurological symptoms. A full body computed tomography scan was performed revealing enlarged mediastinal and mesenteric lymph nodes and multiple lesions in the splenic and hepatic parenchyma indicative of HL. Although a bone marrow biopsy was negative, a liver biopsy was performed, and the diagnosis of HL was confirmed. The patient was treated with chemotherapy and the neurological symptoms resolved completely. Conclusion: This case report highlights the need to include HL in the differential diagnosis in cases of GBS, although it is a rare phenomenon with a possible immunological basis. Early diagnosis and initiation of the appropriate treatment are vital in order to achieve the remission of neurological symptoms and signs. LEARNING POINTS: Neurological manifestations associated with lymphomas are not common and are mainly associated with severe forms and advanced stages of hematologic malignancies.Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy. GBS as a paraneoplastic syndrome is rare in both types of lymphomas, but it is more common in non-Hodgkin's lymphomas.Hodgkin's lymphoma should be included in the differential diagnosis of GBS, while it could be an initial clinical manifestation of Hodgkin's lymphoma in rare cases.