Table 2.
Radiologic, CSF, and exam findings over time in patient.
| Oct 2015 | Dec 2015 | Early Jan 2016 | Late Jan 2016 | June 2016 |
Oct 2016 (post-R-CHOP) |
|
|---|---|---|---|---|---|---|
| PET | Denied by insurance | Focal activity L pectoral/ subpectoral region + brain | ||||
| CT chest | Negative | Negative | ||||
| MRI | ||||||
| Brain | Negative | Multiple enhancing lesions | Complete resolution | |||
| Spine | Negative | Enhancing left C4-C8 Roots | ||||
| MRI BRACHIAL PLEXUS | ||||||
| T2 hyperintensity | Negative | Diffusely hyperintense | Diffusely hyperintense | Reduction | ||
| T1 enhancement | Negative | Negative | Yes, from roots into distal branches | Complete resolution | ||
| CSF | ||||||
| WBC | 18 (81% lymphocytosis) |
9 | 11 (83% lymphocytosis) |
<3 | ||
| Protein (mg/dL) | 48 | 39 | 43 | 56, 70 | ||
| Cytology | Negative | Reactive lymphocytosis | Lymphocytosis with atypical large lymphocytes | Large atypical lymphocytes | ||
| Immunophenotype | Negative | B and T Cell Rearrangement studies negative | Lambda restricted B cell population | |||
| EXAM/SYMPTOMS | ||||||
| Horner's syndrome | Present | Present | Present | Present | Resolved | |
| Left Arm strength | Deltoid IV, biceps/triceps II, WE/WF/FF IV | Deltoid II, Triceps IV, Biceps now I, WE/WF/IO IV | Normal | |||
| Steroid responsiveness | Partial improvement in strength | Partial improvement in strength | ||||
| Pain | Tingling digits IV and V | Axillary pain | Shoulder pain | Resolved | ||
| EMG/NCS | Left lower trunk plexopathy | Left pan- plexopathy, lower trunk predominant | ||||
PET, positron emission tomography; MRI, magnetic resonance imaging; CSF, cerebrospinal fluid; WBC, white blood count; EMG/NCS, electromyography nerve conduction studies, WE, wrist extensors; WF, wrist flexors; FF, finger flexors; IO, interossei.