Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of primary intraocular central nervous system lymphoma with high interleukin 10 level and positive cytology in cerebrospinal fluid

Takuto Hideyama, M.D.1), Hiroshi Tanaka, M.D.1), Yoshikazu Uesaka, M.D.1), Masanari Kunimoto, M.D.1) and Akiyoshi Miwa, M.D.2)

1)Department of Neurology, International Medical Center of Japan
2)Department of Hematology, International Medical Center of Japan

A 73-year-old woman was admitted to the surgical department of our hospital for endoscopic resection of a colonic polyp. The day after endoscopic resection, she became drowsy and dysphasic. Two days later, left hemiparesis and gait difficulty developed. The next day, hemiparesis progressed bilaterally and dyspnea developed due to upper airway stenosis. The most prominent signs were those of bulbar palsy. Blood analysis revealed mild inflammatory responses and hyponatremia. T2-weighted magnetic resonance imaging showed high-intensity lesions in the swollen medulla and cervical spinal cord. Those areas and the meninges of the posterior fossa were enhanced by gadolinium. Steroid pulse therapy was administered, resulting in rapid recovery of bulbar and paretic symptoms with decreased enhanced area. At this point, concentration of cerebrospinal fluid interleukin (IL)-10 was markedly elevated at 146 pg/ml (normal, <5 pg/ml), suggesting malignant lymphoma. Cytology of the cerebrospinal fluid was repeatedly examined, eventually revealing atypical lymphocytes with hyperlobulated nuclei and clear nucleoli. Lymphocytes stained with anti-CD20 antibody. These findings strongly suggested a diagnosis of primary intraocular and central nervous system lymphoma. In the present case, repeated cytology of cerebrospinal fluid was highly important for diagnosis in this case of high IL-10 level in cerebrospinal fluid.
Full Text of this Article in Japanese PDF (480K)

(CLINICA NEUROL, 48: 415|418, 2008)
key words: IL-10, cytology of cerebrospinal fluid, diffuse large B cell lymphoma, MRI

(Received: 4-Jan-07)