Brachial Plexopathy and Horner Syndrome as Presenting Symptoms for Non-Hodgkin’s Lymphoma

Background: the neurologic symptoms that appear due to paraneoplastic syndrome may give manifestations of undiagnosed tumor, but in this case brachial plexopathy accompanied with Horner syndrome were the first manifestations of non-Hodgkin lymphoma as paraneoplastic syndromes that preceded the diagnosis of the disease by about two years. Case presentation: in this case we report a 27 years old man who suffered from severe pain and weakness in the right upper limb, accompanied with right Horner syndrome. Clinical discussion: at the beginning of his complaint all the laboratory and radiographic investigations; CT scan, MRI for cervical spine and brachial plexus were negative except for the presence of marked thickening of the trunks, roots, and cords of the right brachial plexus that enhanced with gadolinium injection, after few months his symptoms developed include difficulty swallowing and hoarseness and lower extremities weakness, whole-body FDG-PET imaging was performed and showed right side cervical vertebral ganglia at the level of second and third vertebrae which was biopsied and showed: Diffuse large B-cell non-Hodgkin’s lymphoma. He began with treatment to which the tumor responded well. Conclusion: patients with brachial plexopathy, Horner syndrome, cervical spine myelopathy and peripheral neuropathy as manifestations for paraneoplastic syndrome of non-Hodgkin lymphoma are very rare and maybe this is the first case in worldwide.