Neuroleukemiosis: Two Case Reports

Voin,; Khalid, Safoorah; Shrager, Sebastian; Rs, Tubbs; Greiner, Robert; Thamburaj, Krishnamurthy; Rizk, Elias

doi:10.7759/cureus.1529

Cited by 7 publications

(9 citation statements)

References 9 publications

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“…However, it was not associated with EMR, suggesting that the GVL effect did not extend to the extramedullary sites [3]. Previous case reports of EMR in the brachial plexus revealed that GVHD occurred before or after the relapse [8][9][10]. Our patient had concurrent development of cGVHD and EMR in the brachial plexus.…”

Section: Discussionmentioning

confidence: 44%

“…Three cases of EMR in the brachial plexus without HSCT were diagnosed clinically due to systemic relapse [5][6][7]. In addition, three previous case reports involved cases of EMR in the brachial plexus in patients with AML who underwent HSCT [8,9]. Two of these cases were definitively diagnosed via biopsy and successfully treated with chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Extramedullary relapse of acute myeloid leukemia in brachial plexus after allogeneic stem cell transplantation: a case report

et al. 2022

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Background Allogeneic hematopoietic stem cell transplantation is a potentially curative treatment for acute myeloid leukemia. However, extramedullary relapse of acute myeloid leukemia can occur after hematopoietic stem cell transplantation, causing treatment failure. Extramedullary relapse rarely involves the peripheral nerves, and it is not influenced by the effect of the graft on leukemia. Case presentation We report a case of extramedullary relapse of acute myeloid leukemia in the brachial plexus of a 41-year-old woman treated with allogeneic hematopoietic stem cell transplantation (HSCT). Complete hematological remission was confirmed by bone marrow examination 1 month after HSCT, and she developed no major complications immediately after HSCT. The immunosuppressant was discontinued 5 months later. However, 2 weeks after immunosuppressant withdrawal, the patient developed left arm pain and paresthesia, with subsequent development of a mass in the left brachial plexus. She was initially diagnosed with brachial plexus neuropathy because of concomitant graft-versus-host disease. Despite the administration of immunosuppressive agents, the mass continued to enlarge. The biopsy of the lesion revealed leukemic relapse. Thus, the patient was diagnosed with extramedullary relapse and underwent radiotherapy, resulting in tumor shrinkage. Conclusion Extramedullary relapse should be considered a differential diagnosis in post-transplant patients with leukemia presenting with paresthesia.

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Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Extramedullary relapse of acute myeloid leukemia in brachial plexus after allogeneic stem cell transplantation: a case report

et al. 2022

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“…Neuroleukemiosis is a very rare complication of leukemia. Until now, only 15 cases have been reported ( Table 1 ) [ 1 – 12 ]. Including the case described in this report, the mean age of patients was 40.2 years, and four patients were aged < 20 years.…”

Section: Discussionmentioning

confidence: 99%

“…Intractable neuropathic pain, numbness, and weakness can be the first signs of neuroleukemiosis. With only neuropathic symptoms present, it is easy to misdiagnose a leukemic mass infiltrating the peripheral nervous system, especially if the blood smear and bone marrow biopsy are negative for leukemia [ 12 ]. Differential diagnosis for neuroleukemiosis include Guillain-Barre syndrome, neurotoxicity from chemotherapy and abscess [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical usefulness of ultrasound as an early diagnostic tool for neuroleukemiosis -a case report-

Baek

Lee

Chung

et al. 2021

Korean J Anesthesiol

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Background: Neuroleukemiosis is a rare complication of leukemia. The diagnosis may be delayed owing to non-specific symptoms and the need for special diagnostic modalities. Case: A 70-year-old man in his sixth year of remission from acute myeloid leukemia was referred to the pain clinic for shooting and radiating pain in the left posterior leg. A lumbar spine magnetic resonance imaging showed mild disc bulging of the L2-3, which was insufficient to explain the patient’s symptoms. With insufficient pain response to lumbar epidural block and piriformis injection, we examined both sciatic nerves using an ultrasound and identified an enlarged hypoechoic mass on the left sciatic nerve at mid-thigh level. After that, we biopsied the mass under general anesthesia, and histology confirmed it to be neuroleukemiosis. Conclusions: Ultrasound is an inexpensive, non-invasive, simple, and quick diagnostic modality that can be used as a screening tool in the diagnosis of neuroleukemiosis.

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“…However, its diagnosis is sometimes delayed because neurological symptoms often occur during the remission phase, and nonspecific symptoms such as paresthesias in AML patients are sometimes considered to indicate neurotoxicity from chemotherapy. 2,3,[5][6][7] Nerve biopsy is a gold standard for the diagnosis of neuroleukemiosis, but it is not recommended if there is a concern that this may result in neurological deficit. 1 As with our patient, the clinical features, imaging findings, and treatment response support the diagnosis of neuroleukemiosis when nerve biopsy is not possible.…”

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confidence: 99%

A case of neuroleukemiosis: The usefulness of nerve ultrasound as a diagnostic tool

et al. 2022

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A case of neuroleukemiosis: The usefulness of nerve ultrasound as a diagnostic toolNeuroleukemiosis is a condition in which leukemic blasts infiltrate peripheral nerves with or without central nervous system involvement. 1 Herein, the authors report a patient with acute myeloid leukemia (AML) for whom peripheral nerve ultrasound was helpful for the diagnosis of neuroleukemiosis in the tibial nerve.A 52-y-old female with AML became aware of paresthesias of the left lower limb. She had been diagnosed with M5b type AML 1 y prior to the onset of the symptom, and undergone remission induction and consolidation therapy, including daunorubicin, cytarabine, and mitoxantrone.After achieving remission, she had also undergone allogenic hematopoietic stem cell transplantation 6 mo prior to the neurological symptom onset. The patient was seen for neurological evaluation 4 mo after onset of paresthesias. On a neurological examination, her cognitive function was normal and there was no involvement of cranial nerves. There was no upper limb weakness. She demonstrated grade 3/5 Medical Research Council (MRC) strength of left plantar flexion and toe flexion. Strength of other muscles in the left lower extremity and of all muscles in the right lower extremity was normal. The patient had hypoalgesia of the right toe

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Neuroleukemiosis: Two Case Reports

Cited by 7 publications

References 9 publications

Extramedullary relapse of acute myeloid leukemia in brachial plexus after allogeneic stem cell transplantation: a case report

Extramedullary relapse of acute myeloid leukemia in brachial plexus after allogeneic stem cell transplantation: a case report

Clinical usefulness of ultrasound as an early diagnostic tool for neuroleukemiosis -a case report-

A case of neuroleukemiosis: The usefulness of nerve ultrasound as a diagnostic tool

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