DIFFUSE LARGE B-CELL LYMPHOMA WITH ISOLATED CENTRAL NERVOUS SYSTEM RELAPSE WITH COMPLETE CENTRAL DIABETES INSIPIDUS

CASE REPORT AND LITERATURE REVIEW

Abstract

CASE
A 35-year-old Thai female was diagnosed with diffuse large B cell lymphoma (DLBCL) stage IV with CNS involvement in March 2021. She was lost to follow-up after chemotherapy. In October 2022, she presented with cauda equina syndrome and subsequently received wholebrain therapy. She developed complete central diabetes insipidus (DI) and secondary hypothyroidism nine months later. The hypothalamic-pituitary-adrenal axis remained intact at that time. MRI of the brain revealed a faint posterior pituitary bright spot, intact pituitary stalk, and brain parenchymal involvement compatible with disease progression. One month after brain radiotherapy, she developed adrenal insufficiency (AI). We reviewed a series of cases similar to our patient with DLBCL relapse, isolated CNS involvement, initial DI and hypothyroidism, and subsequent AI. We suggest careful evaluation of pituitary function in patients with DLBCL with CNS involvement for early diagnosis and optimal pituitary hormone replacement therapy.