Case Report
A 47-year-old man complained of chronic diarrhea and general weakness in November 2019, and a homogeneous reinforcing mass of 7.5 cm in diameter was observed in the abdominal computed tomography (CT) at the terminal ileum. The ileocolectomy was performed, and Burkitt’s lymphoma was diagnosed based on pathology. He received chemotherapy with agents including cytarabine for a total of 4 cycles to treat Burkitt’s lymphoma. The patient reported ataxia of upper and lower extremities with a gaze-induced nystagmus and dysarthria. He showed ataxic gait.
Brain magnetic resonance imaging (MRI) revealed that there was no structural abnormality confirmed in the cerebellum regarding the symptoms. Based on normal laboratory tests, clear cerebrospinal fluid (CSF) analysis and no definite abnormality in brain MRI, we have excluded metabolic disorders, central nervous system infections, and other brain lesions, including stroke, abscess or tumor. In addition, neuromuscular diseases such as Miller-Fischer syndrome were excluded by normal nerve conduction study and needle electromyography. For further evaluation, positron emission tomography-computed tomography (PET-CT) was performed, and the examination revealed a reduced glucose uptake in the cerebellum. Since we previously ruled out other causes, we concluded as a chemotherapy-induced cerebellar ataxia. He was transferred to a rehabilitation unit, and started physiotherapy, occupational therapy and speech therapy for the related symptoms.
After a month of rehabilitation, his ataxic gait pattern improved and he was able to walk indoors independently. The hand function test, Berg balance scale (BBS), Korean version of modified Barthel index (K-MBI), timed up and go (TUG) test and International cooperative ataxia rating scale (ICARS) were all improved compared to the status before the rehabilitation. U-TAP, a tool for assessing dysarthria, had been also improved after speech therapy.
Conclusion
Another case of cerebellar ataxia caused by cytarabine in patient with Burkitt’s lymphoma in the rectum has been reported. If patients with ataxia and dysarthria do not have any abnormal laboratory evidence, CSF study, brain MRI, and electrodiagnosis, PET-CT could be a next tool, especially for who have had chemotherapy with cytarabine. In addition, dysarthria and ataxia can be recovered effectively through a well-designed rehabilitation.
|
