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Case Reports
. 2022 Aug 16;75(4):93-95.
doi: 10.33588/rn.7504.2021367.

Isolated multiple neuropathy as clinical manifestation of leukemia relapse

[Article in English, Spanish]
D Esteller  1 , A Doncel-Moriano  1 , M Claro  1 , L Tardón  1 , J Navarro-Otano  1   2 , E Martínez-Hernández  1   2 , M Suárez-Lledó  1 , A Alejaldre  1
Affiliations
Case Reports

Isolated multiple neuropathy as clinical manifestation of leukemia relapse

[Article in English, Spanish]
D Esteller et al. Rev Neurol. .

Abstract
in English, Spanish

Introduction: Neuroleukemia is a rare disorder of the peripheral nervous system due to leukemic cell infiltration.

Case report: We present the case of a 34-year-old patient with history of acute myelomonoblastic leukemia in remission that presented progressive paresis of the right median, bilateral facial, and left peroneal nerves. The electromyogram confirmed the diagnosis of multineuropathy. A PET-CT showed hypermetabolism of both sciatic, facial, and right median nerves. A bone marrow aspirate confirmed the leukemia relapse so a new round of chemotherapy was performed with improvement of the neurological deficit.

Conclusion: Peripheral nervous system infiltration by leukemic cells can mimic multiple syndromes depending on the structures involved. The nerve-blood barrier acts as a defense of leukemic cells against chemotherapy and the immune system. Thus, the peripheral nervous system constitutes a reservoir of leukemic cells. Neuroleukemia should be considered in patients with history of acute leukemia who have isolated symptoms of the peripheral nerve.

Title: Neuropatía múltiple como manifestación clínica de una recidiva de leucemia.

Introducción. La neuroleucemiosis es una rara enfermedad del sistema nervioso periférico producida por la infiltración por células leucémicas. Caso clínico. Presentamos el caso de una paciente de 34 años con antecedente de una leucemia mielomonoblástica aguda en remisión, que presentaba una parálisis progresiva del nervio mediano derecho, del facial bilateral y del peroneal izquierdo. El electromiograma confirmó el diagnóstico de una neuropatía múltiple. La tomografía por emisión de positrones-tomografía computarizada mostró un hipermetabolismo de ambos nervios ciáticos, facial bilateral y mediano derecho. La biopsia de médula ósea confirmó la recidiva de la leucemia, por lo que se inició un nuevo ciclo de quimioterapia con mejoría de los déficits neurológicos. Conclusión. La infiltración del sistema nervioso periférico por células leucémicas puede simular múltiples síndromes neurológicos dependiendo de las estructuras afectadas. La barrera hematonerviosa actúa como defensa de las células leucémicas contra la quimioterapia y el sistema inmunitario, por lo que el sistema nervioso periférico constituye un reservorio de las células leucémicas. Por ello, la neuroleucemia debe considerarse en pacientes con antecedentes de leucemia que presenten síntomas aislados de afectación del sistema nervioso periférico.

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Conflict of interest statement

Conflicto de intereses: No existen potenciales conflictos de intereses.

Figures

Figura 1
Figura 1
Masas laterocervicales bilaterales que infiltran las glándulas parótidas (a) con realce tras la administración de contraste (b).
Figura 2
Figura 2
Captación de fluorodesoxiglucosa en los nervios ciático-tibial derecho (a) e izquierdo (b y c), mediano derecho (d) y facial bilateral (e).
See this image and copyright information in PMC

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