Summary:
A 37-year-old male patient with a diffuse pleomorphic B-cell-lymphoma, which has been
diagnosed two month earlier with the primary site at the pterygopalatine fossa on
both sides with infiltration of the clivus and cavernous sinus was referred to our
hospital for continuation of the third course of CHOP chemotherapy.
At admission he reported about a recent history of painful swallowing and intermittent
substernal chest pain. Alleviation of the pain on swallowing and the chest pain was
apparently only possible by drinking 10 to 15 l of cold coca cola throughout the day
and night, a regimen that resulted in polyuria. Physical examination revealed extensive
thrush stomatitis and soor esophagitis. Despite successful treatment with fluconazole,
polydipsia continued unabated. The classic osmotic test of dehydration and exogenous
vasopressin revealed hypothalamic diabetes insipidus (DI). Basal hormones and stimulated
endocrine function tests of the adenohypophysis were found to be normal. MRI-scan
revealed lymphoma infiltration of the neurohypophysis. After the third course of CHOP
chemotherapy the patient surprisingly recovered completely from his excessive thirst.
The present report shows that clinical disorders such as thrush stomatitis can mask
diabetes insipidus caused by an early relapsing lymphoma.
Key words:
Diabetes insipidus - B-cell lymphoma - stomatitis
