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Case Report
An unusual cause of encephalopathy in the setting of a new diagnosis of DLBCL
1 University of Utah School of Medicine, 50 Medical Dr N, Salt Lake City, UT 84132, USA
2 University of Utah Department of Internal Medicine, 50 Medical Dr N, Salt Lake City, UT 84132, USA
3 Medicine in the Division of Hematology at the Huntsman Cancer Center, University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA
Address correspondence to:
Isabella Frances McNamara
University of Utah School of Medicine, Salt Lake City, Utah 84132,
USA
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Article ID: 100094Z10IM2021
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McNamara IF, Rizzi S, Still B, Shah H. An unusual cause of encephalopathy in the setting of a new diagnosis of DLBCL. J Case Rep Images Oncology 2021;7:100094Z10IM2021.ABSTRACT
A 69-year-old woman presented with progressive lethargy and encephalopathy of two weeks duration. Initial laboratory workup revealed hypercalcemia; imaging was notable for a 16 cm by 16 cm right lower quadrant abdominal mass. Core biopsy revealed germinal center Diffuse Large B-Cell Lymphoma (DLBCL). Despite correction of her hypercalcemia, the patient’s encephalopathy persisted. Brain imaging, thyroid stimulating hormone (TSH), folate, B12, urinalysis and culture, antinuclear antibody (ANA), and ammonia were normal. Cerebrospinal fluid (CSF) was negative for leptomeningeal disease. A thiamine level was sent and found to be low. Aggressive repletion was pursued; following the first cycle of chemotherapy, the patient’s mental status normalized. This is a rare case in which the rapid turnover of cells in the setting of active malignancy is believed to play a role in the development of thiamine depletion and resultant encephalopathy.
Keywords: Diffuse Large B-Cell Lymphoma, Encephalopathy, Thiamine
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Acknowledgments
Isabella F. McNamara was the primary author of this paper, with Scott A. Rizzi, MD and Bryan Still, MD also contributing significantly to both adding content and editing. Harsh Shah, DO oversaw the writing of this manuscript and provided critical feedback.
Author ContributionsIsabella Frances McNamara - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Scott Rizzi - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Bryan Still - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Harsh Shah - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Isabella Frances McNamara et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
