Numb Chin Syndrome as the Initial Manifestation of High-Grade B-Cell Lymphoma: A Case Report

Case Diagnosis: Numb Chin Syndrome secondary to high-grade B-cell lymphoma.

Case Description or Program Description: A 63-year-old male initially presented with numbness in the chin, which ultimately led to a diagnosis of stage IV high-grade gastric B-cell lymphoma with bone marrow involvement, confirmed by PET-CT. He underwent six cycles of DA-EPOCH-R chemotherapy, achieving remission with no residual disease on follow-up PET-CT. However, despite treatment, he continued to experience neuropathic symptoms in the chin and lower lip, leading to difficulty eating and biting his lip. A facial CT scan showed no aggressive sclerotic or lytic lesions. His symptoms were managed with desensitization techniques, jaw exercises, and acupuncture treatments.

Setting: Tertiary care hospital

Assessment/Results: This case highlights chin numbness as an initial symptom of high-grade B-cell lymphoma. The patient initially reported chin numbness and difficulty opening his jaw, later recognized as Numb Chin Syndrome, leading to the diagnosis of stage IV lymphoma. Although his condition improved with chemotherapy, residual symptoms persisted, affecting his function and overall well-being.

Discussion (relevance): This case emphasizes the importance of recognizing Numb Chin Syndrome as a potential early sign of an underlying malignancy. In this patient, chin numbness was the only initial symptom of high-grade B-cell lymphoma. Even after achieving remission, persistent neuropathic symptoms may require a multidisciplinary approach for optimal management.

Conclusions: Numb Chin Syndrome can be an early manifestation of high-grade B-cell lymphoma. This case underscores the need for early identification and thorough evaluation of neuropathic symptoms of unclear etiology to rule out potentially life-threatening conditions.