A patient with mesenteric lymphoma who developed amyotrophic lateral sclerosis and sepsis

We treated a patient with mesenteric lymphoma who concomitantly developed amyotrophic lateral sclerosis (ALS). The patient died of urinary tract infection nine months after the onset of ALS. We herein report the changes in the patient's condition and the sequence of events until death from the viewpoint of a physiotherapist. The patient was a 69-year-old woman who developed mesenteric lymphoma in September of X year and perceived weakness in the toes in November of X year. She showed signs of upper and lower motor neuron disorders, and electrophysiologic testing revealed denervation in three areas of the spinal cord. In March of X+1 year, she was diagnosed with definite ALS based on the Awaji criteria. In April of X+1 year, she began to receive continuous home healthcare, specifically outpatient rehabilitation. No remarkable bulbar palsy was observed soon after the initiation of rehabilitation; however, manual muscle testing revealed strengths in the lower and upper limbs of 1 and 3-5, respectively, indicating muscle weakness and muscle atrophy. She developed exacerbation of neurological symptoms in the upper limbs, bulbar palsy, and respiratory muscle paralysis during rehabilitation. The ALS Functional Rating Scale-Revised indicated a decreased tendency to X [please define X]. In July of X+1 year, the mesenteric lymphoma had enlarged, resulting in the development of ureteric obstruction and ultimately causing hydronephrosis. Urinary tract infection and sepsis were diagnosed, and she was hospitalized. Although her fever temporarily subsided following ceftriaxone administration, she ultimately died due to a systemic inflammatory response syndrome three days after hospitalization. The mean period between the ALS onset and death is reportedly 40.6±33.1 months. The rate of ALS progression differs among individuals. Malignant tumors and paraneoplastic neurological syndrome may be involved in rapidly worsening neurological symptoms. Patients who concomitantly develop motor neuron disorders and malignant tumors are likely to have a higher risk of developing serious conditions associated with the exacerbation of neurological symptoms and complications. Our patient had several diseases that affected her survival prognosis; however, the sharing of information regarding her condition among healthcare professionals may have been insufficient. The primary physician responsible for treating each disease should cooperate with physiotherapists and other paramedical staff who have frequent opportunities to talk to patients in daily clinical practice. In geriatric patients in particular, such an environment is essential.