Central pontine myelinolysis in diffuse large B-cell lymphoma, a case series and literature review

Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma in Saudi Arabia. Osmotic demyelination syndrome (ODS) is divided into central pontine myelinolysis (CPM) and extrapontine myelinolysis. The occurrence of osmotic demyelination syndrome is classically described in the setting of rapid correction of hyponatremia. Clinical Manifestations are variable, ranging from asymptomatic cases to quadriparesis and locked-in syndrome in the severe form. We reported a total of six cases with diffuse large B-cell lymphoma (DLBCL) that developed central pontine myelinolysis. A literature review was done reviewing all case reports of central pontine myelinolysis occurring in patients with non-Hodgkin lymphoma. A total of 16 patients were reviewed, including our six cases and ten patients from published reports. Nine out of 16 were asymptomatic (56.3%), and DLBCL was present in all cases except one (93.8%). Risk factors such as fluctuations in osmolality or hypoalbuminemia were documented in 9 out of the 16 cases (65.3%), and none had undergone overly rapid sodium correction. The outcome was favorable in all cases, with no residual neurological deficits. DLBCL can predispose to pontine changes suggestive of CPM with a relatively favorable prognosis. The nature of these changes remains uncertain due to lack of histopathological confirmation.