Isolated central nervous system leukemiarelapse presenting as Guillain-Barré-like syndrome: A case report

Abstract

We report the clinical picture, management and outcome of a 14-year-old boy treated for acute lymphoblastic leukemia (ALL) in whom isolated central nervous system relapse manifested by a Guillain-Barré-like syndrome (GBS). While on maintenance chemotherapy for his first CNS-relapse, he developed acute progressive lower motor neuron right facial palsy and marked hypotonia and areflexia of both lower limbs with otherwise no systemic manifestations. Vincristine-induced neuropathy (VIN) was suspected but his electrophysiological evaluation revealed a proximal demyelinating polyradiculoneuropathy pattern suggestive of GBS, but his cerebrospinal fluid analysis showed increased protein and infiltration by 95% leukemic blast cells. Immunoglobulins and chemotherapy were initiated. Although GBS in children with ALL is very rare, differentiating it from VIN by electrophysiological studies and excluding CNS relapse is crucial to determine the proper treatment and ensure a better clinical outcome.