High-grade B-cell lymphoma presenting with bulbar palsy and Tapia syndrome

Rationale: Bulbar palsy and Tapia syndrome (ipsilateral recurrent laryngeal and hypoglossal nerve palsy) are rarely the initial manifestations of lymphoma. Motor neuron disease is often the primary consideration in such cases, potentially leading to diagnostic delay. Patient concerns: A 46-year-old male was admitted to the hospital on April 16, 2020, with the chief complaint of “dysphagia for 7 days.” Diagnosis: High-grade B-cell lymphoma. Interventions: The patient received swallowing function rehabilitation training after admission. On May 12, 2020, a biopsy of a painful mass in the right mandibular area was performed. On May 20, 2020, systemic anti-tumor therapy was administered based on immunohistochemistry and FISH results. Outcomes: At the 2-month follow-up, the patient showed further weight loss, extensive extranodal and multi-organ involvement, indicating a poor prognosis. Lessons: Lymphoma can present with isolated bulbar palsy and Tapia syndrome, mimicking motor neuron disease. Recognizing B symptoms and atypical neuroimaging findings is essential for early diagnosis. Furthermore, the etiology of carotid stenosis in lymphoma patients is often multifactorial, and treatment decisions must balance stroke prevention against bleeding and other tumor-related risks.