Acute Thoracic Cord Compression in Neurofibromatosis Due to Secondary Spinal Epidural Involvement of Systemic B-cell Non-Hodgkin Lymphoma: A Diagnostic Challenge

Spinal epidural involvement by non-Hodgkin lymphoma (NHL) is an uncommon manifestation and a rare cause of acute spinal cord compression, particularly when occurring late in the disease course. Diagnostic challenges may arise due to radiological overlap with more common extradural pathologies, and these challenges are further amplified in patients with neurofibromatosis. We report the case of a 60-year-old woman with a long-standing history of B-cell NHL and neurofibromatosis who presented with acute progressive bilateral lower-limb weakness. Imaging revealed a thoracic epidural mass causing significant spinal cord compression in the setting of systemic disease recurrence. The patient underwent urgent surgical decompression with excision of the extradural lesion, resulting in neurological improvement. Histopathological and immunohistochemical analysis confirmed recurrent B-cell NHL. This case highlights the importance of early recognition, the role of surgical decompression for neurological recovery and tissue diagnosis, and the need for a multidisciplinary approach in managing secondary epidural involvement from previously diagnosed systemic lymphoma rather than a primary spinal epidural lymphoma, especially in patients with coexisting neurofibromatosis.