Multiple drugs

Abstract

Lack of efficacy: case report A 78-year-old woman exhibited lack of efficacy during treatment with primidone, clonazepam, gabapentin, levodopa and levetiracetam for paraneoplastic subacute cerebellar degeneration [routes and dosages not stated]. The woman presented to hospital with unsteady gait and worsened tremor. Examination showed bilateral nystagmus, high amplitude arm tremor, titubation and dysmetria. CT scan of chest/abdomen/pelvis revealed enhancing retroperitoneal tissue. Biopsy showed fibrosis. Positron emission tomography scan showed increased uptake in the retroperitoneal lymph nodes, superior to the retroperitoneal fibrosis noted the on CT scan. Open biopsy showed large B cell lymphoma. CSF was reactive against neural tissue, which revealed the presence of a yet to be described antibody. She was diagnosed with paraneoplastic subacute cerebellar degeneration secondary to B cell lymphoma. She was treated with 6 cycles of R-CHOP therapy. Repeat positron emission tomography scan revealed positive treatment response. Persistent tremor was noted. Despite treatment with gabapentin, levodopa, primidone, clonazepam and levetiracetam, no improvement was noted. She was treated with plasma exchange for 5 days followed by 2 sessions of immune globulin [IVIG] and 4 courses of methylprednisolone without significant improvement.