Acute myeloid leukemia presenting with complete paraplegia and bilateral total blindness due to central nervous system involvement.

Abstract

We report a case of central nervous system (CNS) involvement in a 29-year-old man with acute myeloid leukemia (AML). Although leukemic cell invasion of the CNS in patients with AML has been reported in ~3% cases, multiple invasions of the CNS are rare. A 29-year-old man presented with rapidly progressive flaccid paralysis of the lower extremities. Laboratory findings showed blast cells, accounting for 79% of his white blood cell count. Thoracic spine magnetic resonance imaging showed a T2-hyperintense intramedullary lesion at the T6 level. Peroxidase staining was positive in cells isolated from a paravertebral mass as well as the bone marrow aspirate. The patient was diagnosed as having AML, with CNS involvement. We performed an emergency laminectomy between T6 and T9 with tumor resection. Following chemotherapy, although the patient achieved complete remission, the paraplegia did not improve. The patient showed signs of involvement of the cranial nerves and bilateral total blindness because of the involvement of visual areas in the cortex; these were considered to be caused by another lesion. Furthermore, heterotopic ossification resulted in left hip contractures. Despite the patient achieving complete remission of AML and improvement in overall prognosis, the patient's physical function remained limited.

• Authors: Kohta Asano, Hidetaka Wakabayashi, Naohisa Kikuchi, Hironobu Sashika
• Journal: Spinal cord series and cases (Spinal Cord Ser Cases) Vol. 2 Pg. 15035 ( 2016) ISSN: 2058-6124 [Print] England
• PMID: 28053737 (Publication Type: Journal Article)