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Abstract Details

Neuroleukemiosis Presenting as Mononeuritis Multiplex
Neuro-oncology
P3 - Poster Session 3 (12:00 PM-1:00 PM)
13-013
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Extramedullary tumors can often present at relapse for a patient with acute myeloid leukemia (AML). Uncommonly, this may be accompanied with leukemic nerve infiltration causing painful peripheral neuropathy including moneuritis multiplex. When cancer involvement is proven in the peripheral nervous system it is referred to as neuroleukemiosis. Here we will report a case of neuroleukemiosis in a patient who developed an extramedullary scalp lesion concurrently with wrist drop and peripheral neuropathy. 
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Case: After initial response with induction chemotherapy, the patient developed an extramedullary scalp lesion concurrently with a right wrist drop and a painful peripheral neuropathy. She further developed bilateral wrist drop, then bilateral foot drop as well as a painful peripheral neuropathy in all four extremities. Biopsy of the scalp lesion was consistent with a myeloid sarcoma. EMG was consistent with a multifocal sensory motor axonal neuropathy. Biopsy of sural nerve with lower amplitude was consistent with AML involving the nerve as well. Steroids, plasma exchange were initially attempted to prevent progression for acquired neuropathy.  Chemotherapy was initiated as biopsy results were available with stabilization of symptoms without further progression. There was limited improvement of motor strength.
It is important to consider relapsed leukemia in a patient with new neurologic symptoms in the peripheral nervous system as prompt recognition of the symptoms and prompt diagnosis leads to earlier treatment with effective chemotherapy and prevents unnecessary harm to the patient. Scalp lesion biopsy might provide the clue of leukemic infiltration as well. 
Authors/Disclosures
Michael Youssef, MD (UT Southwestern Medical Center)
PRESENTER 		Dr. Youssef has nothing to disclose.
No disclosure on file
Sudhakar Tummala, MD, FÂ鶹´«Ã½Ó³»­ (MD Anderson Cancer Center) Dr. Tummala has nothing to disclose.