Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website https://jmc.elmerpub.com

Case Report

Volume 16, Number 2, February 2025, pages 61-68

Partial Oculomotor Nerve Palsy as the First Presentation of Extranodal Natural Killer/T-Cell Lymphoma

Figures

↓  Figure 1. Gaze positions demonstrating partial oculomotor nerve palsy with pupillary involvement in the right eye.
Figure 1.
↓  Figure 2. Magnetic resonance imaging (MRI) of the orbit: T2-weighted images demonstrate heterogeneous isointensity in the right superior, medial, and inferior rectus muscles, intraorbital fat, and perioptic nerve sheath complex, with post-gadolinium enhancement. No masses were detected in the paranasal sinuses (PNS). (a) Axial T2-weighted view. (b) Axial T1-weighted view with gadolinium enhancement. (c) Coronal T2-weighted view. (d) Coronal T1-weighted view with gadolinium enhancement. The yellow arrows indicate the position of the right optic nerve.
Figure 2.
↓  Figure 3. Histological and immunohistochemical images of the tumor. (a) The cells are positive for in situ hybridization for Epstein-Barr virus-encoded RNA (EBER) (× 40). (b) The cells are positive for CD3 staining (× 40). (c) The lymphocytes are positive for CD56 staining (× 40). (d) The lymphocytes are positive for TIA-1 staining (× 40).
Figure 3.
↓  Figure 4. Gaze positions demonstrating improvement of oculomotor nerve palsy in the right eye.
Figure 4.

Table

↓  Table 1. Laboratory Test Results of the Case
 
Laboratory test Results (reference range)
AST: aspartate aminotransferase; ALT: alanine aminotransferase.
Complete blood count
  Hematocrit (%) 34.5 (38 - 51.1)
  Hemoglobin (g/dL) 11.8 (12.9 - 17.1)
  White blood cell (WBC) count (/µL) 5,400 (4.5 - 10.5)
  Neutrophils (%) 64.5 (42.7 - 69.6)
  Lymphocytes (%) 22.1 (20.4 - 65.8)
  Eosinophils (%) 1.6 (0.7 - 8.3)
  Monocytes (%) 11.4 (3.8 - 11.2)
  Basophils (%) 0.4 (0.1 - 1.7)
  Platelet count (/µL) 145,000 (162,000 - 402,000)
Renal function
  Blood urea nitrogen (BUN) (mg/dL) 19 (6 - 20)
  Creatinine (mg/dL) 0.9 (0.67 - 1.17)
Electrolytes
  Sodium (mmol/L) 135.7 (136 - 145)
  Potassium (mmol/L) 3.95 (3.5 - 5.1)
  Chloride (mmol/L) 103 (98 - 107)
  Bicarbonate (mmol/L) 24.2 (22 - 29)
Liver function
  Total protein (g/dL) 6.95 (6.6 - 8.7)
  Albumin (g/dL) 3.63 (3.5 - 5.2)
  Total bilirubin (mg/dL) 0.58 (0 - 1.2)
  Direct bilirubin (mg/dL) 0.32 (0 - 0.3)
  AST (U/L) 34 (0 - 50)
  ALT (U/L) 4 (0 - 50)
  Alkaline phosphatase (U/L) 81 (40 - 129)