The clinical picture was suggestive of a neuropathy associated with an underlying malignancy, likely to be a Lymphoma in view of the enlarged lymph nodes.
The patient was therefore referred for an
2. Urgent referral via a two-week cancer pathway to a Consultant Haematologist
3. Urgent CT scan Chest Abdomen and Pelvis
This patient was eventually diagnosed with a T-cell lymphoma following biopsy of lymph nodes. Neuropathies associated with underlying malignancies are not common but can be seen in a pain clinic setting. It is more common to see neuropathies secondary to treatment of malignancy, in particular some classes of chemotherapy drugs.
When considering the aetiology of a peripheral neuropathy, it is useful to think in terms of:
1. Metabolic causes
2. Systemic causes
3. Toxic causes
This month’s recommended reading is on Peripheral Neuropathy. To start with I direct you towards this link: https://www.ncbi.nlm.nih.gov/books/NBK542220/ wherein Claudia Hammi and Brent Yeung present a very good overview of how to manage a patient who presents with symptoms and signs suggestive of this condition. They discuss the management of patients presenting with this condition under the following four headings:
- Identify the aetiology of peripheral neuropathy.
- Describe the appropriate evaluation of a patient with peripheral neuropathy.
- Explain the treatment and management options available for peripheral neuropathy.
- Explain the importance of improving care coordination amongst the interprofessional team to enhance the delivery of care for patients with peripheral neuropathy.
The paper also includes Multiple Choice Questions to help assess your understanding of this condition.