Pulmonary lymphoma in a patient with coeliac disease presenting with paraneoplastic cerebellar degeneration

Neurological complications of coeliac disease are well recognized (e.g. gluten taxia) and T cell lymphoma is an associated complication of this disease. However, pulmonary lymphoma and an associated paraneoplastic phenomenon in a patient with coeliac disease has not been previously reported. There are no previous case reports of pulmonary lymphoma presenting with opthalmoplegia—a paraneoplastic phenomenon. Fifty-five-year-old man presented with diplopia. He had a history of coeliac disease and developed an aggressive T cell pulmonary lymphoma, diagnosed at autopsy. Examination of his cerebellum showed Purkinje cell loss consistent with paraneoplastic cerebellum degeneration. Delay in diagnosis of this condition meant that intervention was not possible. This case demonstrates that diagnosis is difficult but that the possibility should be bourne in mind before attributing cerebellar dysfunction to other pathologies.