Painful ophthalmoplegia in a patient with a history of marginal zone lymphoma

C Van Bogaert; C Mathey; I Vierasu; N Trotta; L Rocq; A Wolfromm; V De Wilde; S Goldman

doi:10.1186/s41824-021-00113-2

Painful ophthalmoplegia in a patient with a history of marginal zone lymphoma

Eur J Hybrid Imaging. 2021 Oct 7;5(1):18. doi: 10.1186/s41824-021-00113-2.

Authors

C Van Bogaert¹, C Mathey², I Vierasu², N Trotta², L Rocq³, A Wolfromm⁴, V De Wilde⁴, S Goldman²

Affiliations

¹ Department of Nuclear Medicine, CUB-Hôpital Erasme, Anderlecht, Belgium. camille.vanbogaert@gmail.com.
² Department of Nuclear Medicine, CUB-Hôpital Erasme, Anderlecht, Belgium.
³ Department of anatomopatholgy, CUB-Hôpital Erasme, Anderlecht, Belgium.
⁴ Department of haematology, CUB-Hôpital Erasme, Anderlecht, Belgium.

Abstract

A 73-year-old man with a history of marginal zone lymphoma was admitted to the emergency room for diplopia and ipsilateral headache. The Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) demonstrated intense and symmetrical hypermetabolism of the cavernous sinuses, and hypermetabolic lesions diffusely in the lymph nodes and bones. The diagnosis of high-grade relapse of lymphomatous disease was made. In this context, the homogenous and symmetric lesion of the cavernous sinuses, without any other encephalic or meningeal lesions, raised the hypothesis of a paraneoplastic origin. A plausible paraneoplastic link between the neuro-ophthalmological lesion and the malignant disorder is IgG4-related disease, a condition that may be associated with lymphoma. As in our case, this diagnosis is often presumptive because histopathological confirmation is difficult to obtain.

Keywords: Lymphoma; Painful ophthalmoplegia; Tolosa Hunt syndrome.