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Case Reports
. 2022 Jun 29;26(2):126-131.
doi: 10.7812/TPP/21.081. Epub 2022 Jun 17.

Chronic Lymphocytic Leukemia With Leptomeningeal Involvement Presenting as an Acute Encephalopathy

William H Bae  1 , Matthew Yee  1 , Leina'ala Song  1 , Monique M Canonico  2 , Philip A Verhoef  1   3 , Kelly A Shimabukuro  4
Affiliations
Case Reports

Chronic Lymphocytic Leukemia With Leptomeningeal Involvement Presenting as an Acute Encephalopathy

William H Bae et al. Perm J. .

Abstract

Introduction Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries. Extramedullary involvement in the central nervous system (CNS) is a rare complication of the disease, and less than 200 cases have been reported. We report a case of leptomeningeal involvement of CLL that presented as an acute encephalopathy. Case presentation A 76-year-old man with treatment-naïve, Rai stage 0 CLL presented with altered mental status. Cerebrospinal-fluid studies, including flow cytometry, confirmed the leptomeningeal involvement of the previously diagnosed CLL. Surveillance imaging and lab studies showed no evidence of disease progression or Richter's transformation. One-time intrathecal methotrexate resulted in transient improvement of his mental status. Conclusion CLL patients with new-onset neurologic manifestations should be evaluated for the CNS involvement of the neoplasm via brain imaging and cerebrospinal-fluid flow cytometry. This CNS involvement of CLL is associated with poor clinical outcomes. Intrathecal treatment with methotrexate, cytarabine, and steroid may improve neurologic symptoms.

Keywords: Case report; Central Nervous System involvement; Chronic Lymphocytic Leukemia; Encephalopathy.

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Conflict of interest statement

Conflicts of Interest: None declared

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