Paraneoplastic Demyelinating Sensorimotor Neuropathy Delaying the Diagnosis of an Underlying Acute Lymphoblastic Leukemia in a Child

Chandar, Rumesh; Seetharam, Shwetha; Gopakumar, K.G.; Appanraj, Priya; Cs, Guruprasad; Rajeswari, Binitha; Nair, Manjusha; Thankamony, Priyakumari

doi:10.1200/jop.18.00200

Cited by 3 publications

(7 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nine patients were reported so far in the literature, including; six children who developed GBS during induction; 7,9-11 two were in remission, 7,12 and only one child presented with GBS as the initial presentation of underlying ALL. 13 Although the clinical and electrophysiological studies of the presented patient were consistent with the AIDP subtype of GBS, a CSF analysis, which is mandatory not only to fulfill ""Brighton diagnostic criteria" " for GBS but also because of the possibility of CNS-relapse in a known patient with ALL. 14 It revealed the presence of blast cells indicating leukemic infiltration due to CNS relapse.…”

Section: Discussionmentioning

confidence: 59%

“…20 A paraneoplastic demyelinating sensorimotor neuropathy has been also suggested. 13 In conclusion, although GBS in children with ALL is very rare, differentiating it from VIN by electrophysiological studies, and excluding underlying leukemia relapse, especially the isolated CNS type, is crucial to determine the proper diagnosis, treatment, and improve the clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Elmaksoud¹,

Chazli²,

Wali³

2020

HTIJ

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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

Elmaksoud¹,

Chazli²,

Wali³

2020

HTIJ

View full text Add to dashboard Cite

show abstract

“…In contrast to well recognized neurological symptoms reported in ALL which occurs as a result of the chemotherapy side effect or as a initial presentation in the form of cranial nerve involvement, increased intracranial/cerebrospinal fluid pressure, especially in children,8 our patient’s ALL initial manifestation was polyradiculopathy in adulthood and he had not been exposed to any chemotherapeutic agents. Few studies have reported that patients can show symmetrical polyradiculopathy as an initial presentation of ALL 7,9…”

Section: Discussionmentioning

confidence: 99%

Acute Lymphoblastic Leukemia Masquerading as Guillain-Barré Syndrome

Al-Chalabi¹,

Ali²,

Lim³

et al. 2021

The Neurologist

View full text Add to dashboard Cite

Introduction: Neurological manifestations of acute lymphoblastic leukemia (ALL) have been reported as cranial neuropathies or meningeal symptoms most common in children. However, ALL can rarely involve the nerve roots causing symmetrical polyradiculopathy which can present with rapid onset paralysis, mimicking Guillain-Barré Syndrome (GBS). The symmetrical polyradiculopathy can be the earliest manifestation of ALL occurring even before the hematological and systemic manifestations. Case Report: We report a case of a healthy 29-year-old man who presented with subacute bilateral lower extremity weakness and numbness preceded by a respiratory infection. He was initially treated as a suspected (GBS) but cerebrospinal fluid (CSF) findings suggested an alternative diagnosis. His prior TB exposure created a diagnostic confusion. Lumbar spine magnetic resonance imaging revealed nerve root enhancements at L4-L5 and L5-S1 that are seen in GBS and TB arachnoidids. Brain magnetic resonance imaging demonstrated bilateral distention of the optic nerve sheath complexes with CSF suggestive of intracranial hypertension. CSF revealed elevated protein, nucleated cells 2145 leukocytes/mm3, numerous atypical lymphoid cells. He was later diagnosed with ALL associated symmetrical polyradiculopathy presenting with GBS-like symptoms. Conclusion: Symmetrical polyradiculopathy is a rare complication of ALL and can be confused with acute inflammatory demyelinating polyneuropathy. ALL associated polyradiculopathy in young individuals can be clinically indistinguishable from GBS. Our case highlights that when CSF findings are atypical for GBS, ALL should be considered on the differential diagnosis in patients presenting with GBS like symptoms.

show abstract

“…65,142,148 Children more typically develop autoimmune encephalitis rather than peripheral nerve dysfunction, 149 but rare cases of paraneoplastic neuropathy are reported. 54–56 A 13-year-old boy with Hodgkin’s disease was reported with an acute polyneuropathy and autoimmune hemolytic anemia. 54 Axonal degeneration in the nerves and dorsal funiculus was identified on pathological assessment, and these nerves had no evidence of metastatic spread or cellular inflammation.…”

Section: Malignancies and Reticulosesmentioning

confidence: 99%

“…Occasional cases of atypical pediatric AIDP and CIDP represent a paraneoplastic complication of lymphoreticular malignancies. [55][56][57][58] Improvement is reported with IVIG and supportive care. 57 Development of peripheral neuropathy in a patient with non-Hodgkin's malignant lymphoma (NHML) is an indication for intensification of chemotherapy.…”

Section: Paraneoplastic Neuropathiesmentioning

confidence: 99%

Peripheral nerve disease secondary to systemic conditions in children

Wilmshurst

Ouvrier

Ryan

2019

Ther Adv Neurol Disord

View full text Add to dashboard Cite

This review is an overview of systemic conditions that can be associated with peripheral nervous system dysfunction. Children may present with neuropathic symptoms for which, unless considered, a causative systemic condition may not be recognized. Similarly, some systemic conditions may be complicated by comorbid peripheral neuropathies, surveillance for which is indicated. The systemic conditions addressed in this review are critical illness polyneuropathy, chronic renal failure, endocrine disorders such as insulin-dependent diabetes mellitus and multiple endocrine neoplasia type 2b, vitamin deficiency states, malignancies and reticuloses, sickle cell disease, neurofibromatosis, connective tissue disorders, bowel dysmotility and enteropathy, and sarcoidosis. In some disorders presymptomatic screening should be undertaken, while in others there is no benefit from early detection of neuropathy. In children with idiopathic peripheral neuropathies, systemic disorders such as celiac disease should be actively excluded. While management is predominantly focused on symptomatic care through pain control and rehabilitation, some neuropathies improve with effective control of the underlying etiology and in a small proportion a more targeted approach is possible. In conclusion, peripheral neuropathies can be associated with a diverse range of medical conditions and unless actively considered may not be recognized and inadequately managed.

show abstract

Paraneoplastic Demyelinating Sensorimotor Neuropathy Delaying the Diagnosis of an Underlying Acute Lymphoblastic Leukemia in a Child

Cited by 3 publications

References 2 publications

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

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

Acute Lymphoblastic Leukemia Masquerading as Guillain-Barré Syndrome

Peripheral nerve disease secondary to systemic conditions in children

Contact Info

Product

Resources

About