Anti-Myelin Associated Glycoprotein Polyneuropathy in a Patient With Lymphoma and its Resolution After Chemotherapy

Nisar Ahmad, Sajjad Haider, Muzaffar Jameel, Zainab Shahid, Marwan Yared, Saad Z Usmani

Abstract


Anti-myelin associated glycoprotein (anti-MAG) antibody associated polyneuropathy is a chronic distal symmetric sensorimotor neuropathy. The rarity of this condition precludes establishment of a standard of care. It has been treated with steroids, intravenous immunoglobulin (IVIG) and Rituximab. We present a case of a 72 years old man presenting with 1 year history of neuropathic pain in lower extremities and hands bilaterally, right cervical lymphadenopathy on physical exam, and the anti-MAG antibody ELISA was positive. An excisional biopsy of the cervical lymph node showed diffuse large B cell lymphoma. The staging bone marrow examination did not show lymphoma involvement, the PET/CT did only demonstrated neck and mediastinal lymphadenopathy. The patient received four cycles of R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone) for Stage IIA disease with complete response, and complete resolution of polyneuropathy after the first cycle of chemotherapy. The case report highlights the successful treatment of a rare presentation of anti-MAG polyneuropathy associated with early stage diffuse large B-cell lymphoma.




doi: http://dx.doi.org/10.4021/jmc1399w


Keywords


Anti-MAG antibody; Polyneuropathy; Lymphoma

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