1110 - Small Symptom, Big Consequence: Spinal Cord Involvement in Diffuse Large B-Cell Lymphoma

Case Diagnosis: Intramedullary spinal cord involvement (CNS relapse) of Diffuse Large B-Cell Lymphoma (DLBCL).

Case Description: A 60-year-old male with diffuse large B-cell lymphoma (DLBCL) achieved a partial response to chemotherapy with imaging showing only residual smaller neck nodules. Shortly after patient presented with complaints of abdominal numbness and mild urinary retention attributed to BPH. Two months later, the patient developed a spinal cord injury rendering him wheelchair bound. PET CT scan showed FDG intramedullary lesion. The patient was started on aggressive chemotherapy, but was unable to complete the therapy due to progression of CNS disease and other medical complications.

Discussions: Failure to recognize urinary retention as a red flag delayed the diagnosis of spinal cord involvement, leading to irreversible neurological injury, progression of disease, and profound loss of mobility. Intramedullary spinal cord involvement of DLBCL is rare and carries a poor prognosis, but earlier imaging and CNS-directed therapy may preserve neurological function and improve outcomes.

Conclusions: Clinicians must maintain a high index of suspicion of new onset symptoms in cancer patients as they may represent progression of disease. Once spinal cord injury occurs, outcomes remain limited despite aggressive treatment. This case highlights an uncommon complication of DLBCL and the importance of clinician vigilance and education on subtle but critical warning signs. Timely detection is the most effective strategy to reduce morbidity and optimize outcomes.