Submit
     
Case Report
 
Paraplegia as initial presentation of acute myeloid leukemia: A case report
Adama Isah Ladu1, Aisha Abba Mohammed2, Halima Talba3, Yakaru Kundili4, Yakura Abba Kawu3, Ridhwan Aliyu Tukur3
1MBBS, MSc, FMC Path: Lecturer 1/ Consultant Haematologist
2MBBS, FMC Path: Lecturer 1/ Consultant Haematologist
3MBBS, Registrar
4MBBS, Senior Registrar

Article ID: Z01201711CR10846AL
doi:10.5348/ijcri-2017107-CR-10846

Address correspondence to:
Adama Isah Ladu
Department of Haematology and Blood Transfusion
University of Maiduguri Teaching Hospital
Borno State
Nigeria

Access full text article on other devices

  Access PDF of article on other devices

[HTML Abstract]   [PDF Full Text] [Print This Article]
[Similar article in Pumed] [Similar article in Google Scholar]

How to cite this article
Ladu AI, Abba AM, Talba H, Kundili Y, Abba Kawu Y, Tukur RA. Paraplegia as initial presentation of acute myeloid leukemia: A case report. Int J Case Rep Images 2017;8():703–706.


ABSTRACT

Introduction: Acute myeloid leukemia (AML) represents a state of dysregulated clonal expansion of immature myeloid progenitor cells with arrest of differentiation at a particular stage. Involvement of the central nervous system (CNS) may result acutely from the disease at the initial diagnosis, and the symptoms range from muscle weakness, paresthesias, and hypoesthesia to fecal and urinary incontinence. Paraplegia is an extremely rare initial presentation of undiagnosed leukemia.
Case Report: A 15-year-old girl presented with acute urinary and fecal incontinence, and a day later developed inability to move both lower limbs. There was two weeks preceding history of fever, malaise and lower back pain, no associated history of paresthesias or numbness. Examination of both lower limbs revealed decreased tone and reflexes with bilateral extensor reflexes and power of 0/5. There was a loss of sensation around the perianal region with absent anal tone. Cranial nerve and sensory examination were normal. Both peripheral blood film and bone marrow aspiration cytology stained with Leishman stain were consistent with acute myeloid leukemia (AML) FAB M-4 subtype. Cerebrospinal fluid analysis was negative for malignant cells. Magnetic resonance imaging of the lumbosacral region was obtained; both T1- and T2-weighted sequences showed no signal intensity in the spinal cord, theca and cauda, with normal signal intensity involving the intervertebral disc. Patient was commenced on supportive therapy and induction chemotherapy using daunorubicin 45 mg/m2 days 1–3 and cytosine arabinoside 200 mg daily days 1–7. However, patient succumbed to her disease and passed away 10 days into treatment as a result of respiratory complication.
Conclusion: Central nervous system involvement is a rare initial presentation of AML. Absence of abnormality on MRI scan does not rule out spinal cord involvement; consequently late recognition may delay treatment and lead to irreversible neurological complication.

Keywords: Acute myeloid leukemia, Central nervous system, Paraplegia



[HTML Full Text]   [PDF Full Text]
Author Contributions
Adama Isah Ladu – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Aisha Abba Mohammed – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Halima Talba – Acquisition of data, Drafting the article, Final approval of the version to be published
Yakaru Kundili – Acquisition of data, Drafting the article, Final approval of the version to be published
Yakura Abba Kawu – Acquisition of data, Drafting the article, Final approval of the version to be published
Ridhwan Aliyu Tukur – Acquisition of data, Drafting the article, Final approval of the version to be published
Guarantor
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Adama Isah Ladu et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.