Guillain-Barré May Unmask Hodgkin’s Lymphoma
Guillain-Barré syndrome (GBS), a rare autoimmune neuropathy that causes rapid muscle weakness and paralysis, may in exceptional cases serve as the first clinical sign of Hodgkin’s lymphoma (HL), according to a recent case report.
A 32-year-old male presented with progressive paraesthesia, lower limb weakness, and double vision that developed over one week. Neurological examination revealed widespread motor and sensory deficits including paraparesis, hypoesthesia, absent tendon reflexes, and sensory ataxia. Cerebrospinal fluid analysis showed albuminocytologic dissociation, and electrophysiological studies confirmed motor demyelinating polyradiculoneuritis consistent with GBS.
Despite treatment with intravenous immunoglobulin over five days, the patient’s symptoms worsened, progressing to severe cranial nerve involvement and tetraparesis. Subsequent plasmapheresis sessions led to partial neurological improvement. A full-body CT scan was then conducted to investigate potential underlying causes and revealed enlarged mediastinal and mesenteric lymph nodes, along with splenic and hepatic lesions. A liver biopsy confirmed Hodgkin’s lymphoma, even though bone marrow findings were negative.
Following chemotherapy, the patient’s neurological symptoms fully resolved, suggesting that the GBS presentation may have been a paraneoplastic manifestation of HL.
This case underscores the importance of considering hematologic malignancies such as Hodgkin’s lymphoma in the differential diagnosis of patients presenting with atypical or treatment-resistant GBS. Though rare, an immune-mediated paraneoplastic mechanism may underlie such presentations, and early identification is crucial to improving neurological outcomes.
Reference: Petrakis V et al. Guillain-Barré Syndrome as the Initial Clinical Manifestation of Hodgkin’s Lymphoma. Eur J Case Rep Intern Med. 2025;12(10):005764.
