Multiple cranial nerve palsies as the initial presentation of peripheral T-cell lymphoma.

Primary non-Hodgkin lymphoma (NHL) rarely affects the sinonasal tract and represents approximately 1.5% of all lymphomas, with a higher incidence in Asia and South America.1-3 In the United States, sinonasal lymphomas are more prevalent in elderly men and are located in the paranasal sinuses. In addition, they are usually of the B-cell subtype,1-2,4-5 in contrast to the T-cell subtype that is more common in Asia.6-10 Most patients present with nasal obstruction, facial swelling, or pain. Central nervous system (CNS) involvement has mainly been reported prior to the initiation of intrathecal chemoprophylaxis and likely results from the invasive nature of the tumor and its proximity to the CNS.4,11 Neurologic manifestations that were described with sinonasal lymphomas include diplopia, visual impairment, and hearing loss.12 To the best of our knowledge, there are no reported cases of concurrent second, third, fourth, fifth, sixth, seventh, or eighth cranial nerve palsies at presentation secondary to sinonasal peripheral T-cell lymphoma not otherwise specified (PTCL-NOS).