Myopathy secondary to intravascular large B-cell lymphoma

Received 2 July 2009; received in revised form 3 September 2009; accepted 7 September 2009.

Abstract

We report a case of a 78-year-old woman presenting with progressive proximal muscle weakness mainly to lower limbs and myopathic EMG associated with intravascular large B-cell lymphoma.

Muscle biopsy showed myopathic changes, intravascular large B-cell lymphoma but no inflammation or fibre necrosis; the patient’s serum cross-reacted with an unidentified nuclear antigen of approximately 45kDa present in muscle and lymphoma cells.

Our case illustrates a myopathy associated with intravascular large B-cell lymphoma probably mediated by antibodies cross-reacting with a nuclear protein expressed by neoplastic cells and normal muscle. The nature of this nuclear antigen remains unidentified.

Keywords: Lymphoma, Myopathy, Autoimmune, Paraneoplastic

a Division of Clinical Neurosciences, Imperial College London, UK

b Kennedy Institute of Rheumatology, Imperial College London, UK

c Department of Histopathology, Imperial College London, UK

d Department of Haematology, Heatherwood and Wexham Park Hospitals NHS Foundation Trust, UK

e Department of Neurological Sciences, University of Rome “Sapienza”, Italy

Corresponding author. Address: Department of Clinical Neuroscience, Division of Neuroscience and Mental Health, Imperial College London, Charing Cross Campus, St. Dunstans Road, London W6 8RP, UK. Tel.: +44 (0) 20 8846 7178; fax: +44 (0) 20 8846 7794.

PII: S0960-8966(09)00597-5

doi:10.1016/j.nmd.2009.09.003

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