Osmotic demyelination syndrome in patients with non-Hodgkin lymphoma: a case report and literature review

An Unusual Case of a Central Pontine Myelinolysis Associated with Primary Splenic Diffuse Large B-cell Lymphoma

A 54-year-old woman with persistent fatigue and a high fever presented with central pontine myelinolysis (CPM) on brain imaging, despite the absence of neurological symptoms. The patient had a slightly low serum sodium concentration. Further investigation led to a diagnosis of primary splenic diffuse large B-cell lymphoma (PS-DLBCL). Brainstem auditory-evoked potentials (BAEP) indicated minor abnormalities. CPM was successfully resolved after splenectomy and immunochemotherapy. This is the first reported case of CPM in a patient with PS-DLBCL confirmed by a pathological diagnosis following splenectomy and BAEP-detected abnormalities that improved with immunochemotherapy.

Osmotic demyelination syndrome in cancer patients: Risk even without rapid sodium correction - a scoping review

OBJECTIVE

To describe the clinical characteristics, therapeutic approaches, and prognostic outcomes of osmotic demyelination syndrome (ODS) in cancer patients.

METHODS

A comprehensive literature search (January 1950-March 2024) using PubMed, Embase, Cochrane Library, and Web of Science. Keywords included "osmotic demyelination and cancer", "central pontine myelinolysis and cancer", and "extrapontine myelinolysis and cancer", "Osmotic demyelination and malignancy," "Central pontine myelinolysis and malignancy," and "Extrapontine myelinolysis and malignancy." References from selected articles were manually reviewed for inclusion. Studies involving benign lesions, surgical interventions, non-malignant ODS, and ODS of unknown etiology without malignancy were excluded.

RESULTS

A total of 22 cases of cancer-complicated ODS were identified in the literature. The median age of onset was 55 years, with no observed gender differences. Clinical presentations ranged from completely asymptomatic (4.5 %,1/22) to disorders of consciousness (27.3 %, 6/22). Notably, 22.7 % (5/22) of patients initially presented with either no symptoms or non-specific symptoms (seizures, abnormal mental behavior) that could be mistaken for hyponatremia itself. Furthermore, 90 % of patients did not experience rapid sodium correction, and 59.1 % received only symptomatic therapy or treatment of the primary cancer. Only 9.1 % of patients received immunoglobulin or plasma exchange, which may improve outcomes.

CONCLUSIONS

Osmotic demyelination syndrome represents a potential complication in cancer patients, potentially arising from complex interactions. Clinical manifestations are highly variable and often under-recognized, particularly by non-neurologists. Traditional sodium correction protocols may still induce ODS in cancer patients, suggesting a need for cautious sodium management. Timely diagnosis and appropriate intervention are crucial for determining patient prognosis.

Occurrence of osmotic demyelination syndrome in diabetes mellitus: A case report and literature review of various etiologies for osmotic demyelination syndrome

Osmotic demyelination syndrome is a rare condition reported mainly in the case of rapid correction of hyponatremia, but it can occur even in the case of complicated diabetes mellitus either during rapid correction of hyperglycemia or anytime during the complicated diabetes mellitus. We report a case of complicated diabetes mellitus developing osmotic demyelination syndrome. The patient had presented with altered sensorium and seizure, which was initially diagnosed as hyperglycemia, but during his treatment, the magnetic resonance imaging of brain revealed central pontine myelinolysis. Our search on the causes of osmotic demyelination syndrome other than rapid correction of hyponatremia has revealed several other causes like autoimmune liver disease, Sjogren’s syndrome and non-Hodgkin’s lymphoma in addition to diabetes mellitus.