{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T20:33:44Z","timestamp":1783110824063,"version":"3.54.6"},"reference-count":31,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,12,11]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>A 69-year-old woman presented with severe subacute painful meningoradiculoneuritis. Neurophysiology showed a patchy, proximal axonal process with widespread denervation. Cerebrospinal fluid (CSF) was lymphocytic (normal T-cell predominant) with negative cytology. MRI revealed multiple sites of enhancement, but fluorodeoxyglucose positron emission tomography was negative. Bone marrow aspirate and trephine (BMAT) showed no evidence of a lymphoproliferative condition. Right brachial plexus biopsy demonstrated mixed T-cell\/B-cell endoneurial inflammation not fulfilling criteria for vasculitis. She was stabilised with high-dose steroids and cyclophosphamide, followed by mycophenolate for inflammatory myeloradiculoneuritis. However, symptoms recurred when prednisolone was weaned. Although T-cell receptor gene analysis from the initial CSF demonstrated clonal rearrangements, it was only when the same clones were identified on two repeat BMATs and CSF that T-cell neurolymphomatosis, an exceedingly rare condition, was diagnosed. This case highlights the diagnostic challenge in peripheral neurolymphomatosis related to patchy disease, variable sensitivity and specificity of investigative tools, and the influence of therapies on traditional cytological definitions of lymphoma. The clinical picture, exhaustive exclusion of alternative causes and the persistence of an abnormal T-cell clone ultimately lead to a diagnostic consensus between specialist neurology and haematology clinicians.<\/jats:p>","DOI":"10.1136\/bcr-2019-232538","type":"journal-article","created":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T04:15:38Z","timestamp":1577679338000},"page":"e232538","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic delay in a case of T-cell neurolymphomatosis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9889-971X","authenticated-orcid":false,"given":"Vivien","family":"Li","sequence":"first","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zane","family":"Jaunmuktane","sequence":"additional","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK"},{"name":"Department of Clinical and Movement Neurosciences, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Cwynarski","sequence":"additional","affiliation":[{"name":"Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisling","family":"Carr","sequence":"additional","affiliation":[{"name":"Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,29]]},"reference":[{"key":"2025082713173883000_12.12.e232538.1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-08-692566"},{"key":"2025082713173883000_12.12.e232538.2","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.56.1.1"},{"key":"2025082713173883000_12.12.e232538.3","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-10-200905190-00004"},{"key":"2025082713173883000_12.12.e232538.4","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-12-258210"},{"key":"2025082713173883000_12.12.e232538.5","doi-asserted-by":"publisher","DOI":"10.1097\/MNM.0b013e3283561881"},{"key":"2025082713173883000_12.12.e232538.6","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2404467"},{"key":"2025082713173883000_12.12.e232538.7","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1093\/jnen\/nly055","article-title":"Pathology of nerve biopsy and diagnostic yield of PCR-based clonality testing in neurolymphomatosis","volume":"77","author":"Duchesne","year":"2018","journal-title":"J Neuropathol Exp Neurol"},{"key":"2025082713173883000_12.12.e232538.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2006.05.044"},{"key":"2025082713173883000_12.12.e232538.9","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2559.2001.01057.x"},{"key":"2025082713173883000_12.12.e232538.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2004.05144.x"},{"key":"2025082713173883000_12.12.e232538.11","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-12-516245"},{"key":"2025082713173883000_12.12.e232538.12","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880141111"},{"key":"2025082713173883000_12.12.e232538.13","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-008-9633-2"},{"key":"2025082713173883000_12.12.e232538.14","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000010303","article-title":"Neurolymphomatosis in non-Hodgkin lymphoma with cranial multineuritis: a case report","volume":"97","author":"Haydaroglu Sahin","year":"2018","journal-title":"Medicine"},{"key":"2025082713173883000_12.12.e232538.15","doi-asserted-by":"crossref","DOI":"10.1212\/01.wnl.0000338598.07063.5b","article-title":"T-Cell neurolymphomatosis involving cauda equina and sciatic nerves","volume":"72","author":"Kosa","year":"2009","journal-title":"Neurology"},{"key":"2025082713173883000_12.12.e232538.16","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1016\/j.clinph.2010.02.123","article-title":"42. 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