Amyotrophic lateral sclerosis in a patient with chronic lymphocytic leukaemia and drug related sarcoid-like reaction
Abstract Sarcoid-like reaction is an immunological reaction that can affect lymph nodes and organs but does not meet the diagnostic criteria for systemic sarcoidosis. Anti-CD20 auto-antibodies have been reported to be responsible for such reactions. There are several reported associations between Ch...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | BMC Neurology |
| Online Access: | https://doi.org/10.1186/s12883-025-04020-y |
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| author | Joumana Freiha Effie Grand Ben Marshall Ramamurthy Arunchalam Ashwin Pinto Chinar Osman |
| author_facet | Joumana Freiha Effie Grand Ben Marshall Ramamurthy Arunchalam Ashwin Pinto Chinar Osman |
| author_sort | Joumana Freiha |
| collection | DOAJ |
| description | Abstract Sarcoid-like reaction is an immunological reaction that can affect lymph nodes and organs but does not meet the diagnostic criteria for systemic sarcoidosis. Anti-CD20 auto-antibodies have been reported to be responsible for such reactions. There are several reported associations between Chronic lymphocytic leukaemia (CLL), Amyotrophic lateral sclerosis (ALS) and Sarcoid-like reactions (SLR). We report a case of ALS developing in a patient with treated CLL and drug related SLR one day after exposure to Venetoclax and Rituximab. A 60-year-old male presented with lower limb rash, left leg weakness followed by bulbar symptoms which progressed over 12-months. Workup demonstrated a Cerebrospinal fluid (CSF) pleocytosis and inguinal lymphadenopathy. Skin and inguinal lymph node biopsies showed non-necrotising granulomata. Electromyography met diagnostic criteria for ALS. He was treated for presumed neurosarcoidosis mimicking ALS. Despite prednisolone and infliximab treatment, the motor symptoms rapidly progressed; Hence, we made a clinical diagnosis of ALS. We discuss the diagnostic and treatment challenges of this case. |
| format | Article |
| id | doaj-art-e9c0d329851c44dcb6315223c1e37fed |
| institution | DOAJ |
| issn | 1471-2377 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj-art-e9c0d329851c44dcb6315223c1e37fed2025-08-20T02:40:35ZengBMCBMC Neurology1471-23772025-01-012511510.1186/s12883-025-04020-yAmyotrophic lateral sclerosis in a patient with chronic lymphocytic leukaemia and drug related sarcoid-like reactionJoumana Freiha0Effie Grand1Ben Marshall2Ramamurthy Arunchalam3Ashwin Pinto4Chinar Osman5Department of Neurology, Wessex Neurological Centre, University Hospital SouthamptonDepartment of Haematology, Salisbury NHS Foundation TrustDepartment of Respiratory Medicine, University Hospital SouthamptonDepartment of Clinical Neurophysiology, Wessex Neurological Centre, University Hospital SouthamptonDepartment of Neurology, Wessex Neurological Centre, University Hospital SouthamptonDepartment of Neurology, Wessex Neurological Centre, University Hospital SouthamptonAbstract Sarcoid-like reaction is an immunological reaction that can affect lymph nodes and organs but does not meet the diagnostic criteria for systemic sarcoidosis. Anti-CD20 auto-antibodies have been reported to be responsible for such reactions. There are several reported associations between Chronic lymphocytic leukaemia (CLL), Amyotrophic lateral sclerosis (ALS) and Sarcoid-like reactions (SLR). We report a case of ALS developing in a patient with treated CLL and drug related SLR one day after exposure to Venetoclax and Rituximab. A 60-year-old male presented with lower limb rash, left leg weakness followed by bulbar symptoms which progressed over 12-months. Workup demonstrated a Cerebrospinal fluid (CSF) pleocytosis and inguinal lymphadenopathy. Skin and inguinal lymph node biopsies showed non-necrotising granulomata. Electromyography met diagnostic criteria for ALS. He was treated for presumed neurosarcoidosis mimicking ALS. Despite prednisolone and infliximab treatment, the motor symptoms rapidly progressed; Hence, we made a clinical diagnosis of ALS. We discuss the diagnostic and treatment challenges of this case.https://doi.org/10.1186/s12883-025-04020-y |
| spellingShingle | Joumana Freiha Effie Grand Ben Marshall Ramamurthy Arunchalam Ashwin Pinto Chinar Osman Amyotrophic lateral sclerosis in a patient with chronic lymphocytic leukaemia and drug related sarcoid-like reaction BMC Neurology |
| title | Amyotrophic lateral sclerosis in a patient with chronic lymphocytic leukaemia and drug related sarcoid-like reaction |
| title_full | Amyotrophic lateral sclerosis in a patient with chronic lymphocytic leukaemia and drug related sarcoid-like reaction |
| title_fullStr | Amyotrophic lateral sclerosis in a patient with chronic lymphocytic leukaemia and drug related sarcoid-like reaction |
| title_full_unstemmed | Amyotrophic lateral sclerosis in a patient with chronic lymphocytic leukaemia and drug related sarcoid-like reaction |
| title_short | Amyotrophic lateral sclerosis in a patient with chronic lymphocytic leukaemia and drug related sarcoid-like reaction |
| title_sort | amyotrophic lateral sclerosis in a patient with chronic lymphocytic leukaemia and drug related sarcoid like reaction |
| url | https://doi.org/10.1186/s12883-025-04020-y |
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