Status Epilepticus as the Initial Manifestation of Follicular Lymphoma with Leptomeningeal Dissemination.
Momoyo Ibukuro, Kenichi Sakuta, Motohiro Okumura et al.
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Case in brief
A 44-year-old man presented with meningoencephalitis and developed status epilepticus. Evaluation showed diffuse leptomeningeal dissemination of grade 1 follicular lymphoma, despite negative cerebrospinal fluid cytology. CSF flow cytometry detected a monoclonal B-cell proliferation and established the diagnosis. He achieved rapid neurological recovery after immunochemotherapy.
What made this case unusual
Follicular lymphoma rarely involves the central nervous system at initial diagnosis; here, diffuse leptomeningeal disease presented with meningoencephalitis and status epilepticus, while CSF cytology was negative.
Diagnostic / clinical pearl
In mononuclear cell-predominant meningoencephalitis unresponsive to empirical therapy, CSF flow cytometry may detect a clonal B-cell population even when cytology is negative.