ABSTRACT
A-46-year-old woman admitted to our hospital because of numbness of bilateral lower limbs and urinary incontinence. The initial neurological examination showed sensory impairment below S1 level with urinary incontinence, indicating epicornus syndrome. Spinal MR imaging demonstrated unremarkable on conventional and enhanced images with Gd-DTPA. Cerebrospinal fluid examination revealed slightly elevated protein level without pleocytosis. Thereafter, subacute ascending myelopathy including flaccid paraparesis and urinary retention, developed. Because the patient had low grade fever, fatigue, weight loss and elevated serum soluble IL-2 receptor and LDH titers, we investigated her for lymphoma. Although lymphadenopathy or mass lesions were not found on whole-body CT scan, bone marrow biopsy showed the presence of inravascular large B-cell lymphoma (IVL). Thus the patient's progressive myelopathy was probably caused by IVL invasion. Ten days after the initiation of chemotherapy, her neurological symptoms transiently improved; however, her paraparesis and urinary incontinence gradually worsened thereafter, despite of treatment. IVL often presents with neurological manifestations, including myelopathy. There have been a few reports of IVL presenting with lower lumbar spinal cord and conus medullaris. It should be noted that IVL can cause unidentified progressive ascending myelopathy without positive MRI findings.
