ABSTRACT
A 58-year-old man with a history of rheumatoid arthritis and stage IV diffuse large B-cell lymphoma, in complete remission with no evidence of residual disease on positron emission tomography/CT after completing six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy, presented with acute onset of dysphagia to solids and liquids. On further evaluation, his dysphagia was attributed to a vagus nerve palsy, and later during his admission, he developed rapidly progressing left facial and vestibulocochlear nerve palsies. Imaging studies displayed pathological enhancement of bilateral seventh and eighth cranial nerves, concerning for leptomeningeal recurrence of lymphoma. Cerebrospinal fluid analysis and flow cytometry were confirmatory, revealing markedly atypical monotypic CD19 positive B cells.
Subject(s)
Cranial Nerve Diseases/pathology , Lymphoma, Large B-Cell, Diffuse/pathology , Meningeal Neoplasms/pathology , Neoplasm Recurrence, Local/pathology , Antineoplastic Combined Chemotherapy Protocols , Cranial Nerve Diseases/drug therapy , Cranial Nerve Diseases/radiotherapy , Diagnosis, Differential , Facial Nerve Diseases/etiology , Humans , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/radiotherapy , Male , Meningeal Neoplasms/drug therapy , Meningeal Neoplasms/radiotherapy , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/radiotherapy , Vestibulocochlear Nerve Diseases/etiologyABSTRACT
PURPOSE: To investigate whether patient-spouse co-reporting (patient reporting with assistance from their spouse) results in the same ratings of health-related quality of life (HRQoL) as patient ratings without co-reporting, and to assess whether mutuality of the marital relationship is a determinant of co-reported ratings. Patients are the best source of HRQoL; however, co-reporting is common in clinical settings, but has not been compared to independent patient reporting of HRQoL. METHODS: Fifty-nine Parkinson's disease (PD) patient-spouse pairs completed the Short Form Health Status Survey (SF-12), measuring mental and physical HRQoL. Initially, the patient and spouse completed the SF-12 independently (about the patient). Then, patient-spouse pairs completed the SF-12 together assessing the patient's HRQoL. Patients and spouses independently completed the Mutuality Scale rating the intimacy of their relationship. RESULTS: Patients rated physical HRQoL higher (M = 46.6) than spouses alone (M = 43.4, p < 0.01) and co-reporting (M = 44.8, p < 0.05). Co-reporting rated physical HRQoL in between that of patients and spouses, (p < 0.05). Spouses who reported greater mutuality showed greater concordance with the patient regarding the patient's mental HRQoL (B = -0.43, p < 0.05). CONCLUSION: Consistency of the mode of completion of HRQoL instruments is important since co-reporting may alter HRQoL ratings in PD and lead to inaccurate conclusions. Mutuality is a mediator of mental HRQoL.
