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Numb chin syndrome as a presenting symptom of diffuse large B-cell lymphoma with secondary myelofibrosis
  1. Arihant Jain1,
  2. Sweta Rajpal1,
  3. Man Updesh Singh Sachdeva1,
  4. Pankaj Malhotra2
  1. 1Department of Clinical Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Department of Hematology and Internal Medicine, PGIMER, Chandigarh, India
  1. Correspondence to Dr Pankaj Malhotra, hematpgi{at}


Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin’s lymphoma that classically presents with rapidly enlarging lymph nodes. We present a 59-year-old man with unusual clinical presentation of numb chin syndrome (NCS) as the first symptom of disease. On evaluation, he was found to have diffuse extranodal skeletal involvement in the form of lytic-sclerotic lesions and minimal lymphadenopathy. Bone marrow biopsy revealed a poorly differentiated tumour with infarction and extensive myelofibrosis. This was subsequently proven to be DLBCL of germinal centre type on immunohistochemical stain. NCS should alarm the clinician to investigate for an advanced underlying malignancy. Extensive myelofibrosis, though described in carcinomas and low grade lymphomas, may also be seen in high grade DLBCL.

  • Anaesthesia
  • malignant and benign haematology
  • cranial nerves
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  • Contributors AJ: senior resident who has seen the patient in outpatient department and was involved in writing the manuscript. SR: senior resident who was involved in making diagnosis of diffuse large B-cell lymphoma in pathology and writing of manuscript. MUSS was involved in making diagnosis of diffuse large B-cell lymphoma and correction of manuscript. PM was the treating physician of this patient and corrected the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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