Persistent Singultus as an Early Symptom in Primary Central Nervous System Lymphoma: A Case Report

Brian Walter, DO, Hyder Tamton, DO, Hector Lalama, MD, Wilson Cueva, MD

 

Larkin Community Hospital, 7031 SW 62^nd Ave South Miami, FL 33124

 

*Corresponding Author: Brian Walter, DO, Larkin Community Hospital, 7031 SW 62^nd Ave South Miami, FL 33124, Phone: +1 901-283-0049 E-mail: bwalter@larkinhospital.com

 

Citation: Brian Walter (2020) Persistent Singultus as an Early Symptom in Primary Central Nervous System Lymphoma: A Case Report. J Neuropsychiatr Neurodis, 2(2);1-5

 

Copyright: © 2020, Brian Walter, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

 

ABSTRACT

 

Introduction: Persistent singultus is a rare, debilitating clinical symptom that has multiple etiologies which includes central nervous system pathology. Regarding central nervous system pathology, brainstem lesions have been found to be most associated with singultus. The present study reports a unique case of persistent singultus as one of the early signs of primary B cell lymphoma of the central nervous system with a lesion localized to the frontal lobe with extension into basal ganglia and cerebral peduncle. Pathophysiologic processes mediating the hiccup reflex arc are explored in this report. Additionally, management of refractory singultus is detailed with attention to pharmacological approach. Case Presentation: Patient is a 46-year-old Hispanic male who initially presented to the emergency department with a 4-day history of disruptive hiccups and fever. Hiccups were reported to start shortly after finishing a 10-day course of doxycycline for the right axillary abscess. The persistent singultus was occurring 8-13 per minute and causing significant impairment to his quality of life and affecting his daily functions including breathing. Patient underwent significant testing and was found to have multiple comorbidities. His complicated hospital course included being diagnosed and treated for Human Immunodeficiency Viruses (HIV)/acquired Immunodeficiency Syndrome (AIDS), disseminated histoplasmosis, central nervous system Epstein Barr Virus (EBV) infection, Cytomegalovirus (CMV) pneumonia in addition to primary B cell lymphoma of the brain. Conclusion: Diagnostic evaluation for space occupying lesions should be considered in patient’s presenting with persistent singultus. Furthermore, refractory singultus may be successfully treated with a multi-regimen pharmacological approach. Our case study also provides clinical support for use of gamma knife radiosurgery in treatment of primary B cell lymphoma of the central nervous system

DOI: http://dx.doi.org/10.47690/JNN.2020.2201

 

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