Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of central nervous system relapse in acute promyelocytic leukemia

Yuhei Hasuike, M.D.1), Hiroshi Yamaguchi, M.D.1), Hideki Mitsui, M.D., Ph.D.2), Yoshiro Nishikawa, M.D., Ph.D.1) and Fuminobu Sugai, M.D., Ph.D.1)

1)Department of Neurology, Otemae Hospital
2)Department of Hematology, Otemae Hospital

A 70-year-old woman who have achieved complete remission (CR) of acute promyelocytic leukemia (APL) with all-trans retinoic acid and chemotherapy presented with abnormal sensation in the right lateral thigh and the bilateral legs. In addition, neurological examination revealed weakness of the left shoulder abduction, the right hand, and the bilateral lower limbs. Atypical promyelocytes were detected in the cerebrospinal fluid, in spite of normal finding in the peripheral blood smear. Magnetic resonance imaging showed gadolinium-enhanced multiple intradural/extramedullary lesions in the whole spine. Nerve conduction studies of the right limbs revealed sensorimotor conduction abnormalities, conspicuously in the posterior tibial and sural nerves. As a result, she was diagnosed as having intrathecal relapse of APL, associated with multiple mononeuropathy. The neurological symptoms were completely disappeared by intrathecal chemotherapy and whole-spine radiotherapy, suggesting that the neuropathy was possibly caused by meningeal infiltration affecting multiple spinal nerve roots. Since extramedullary or intrathecal relapse is extremely rare in APL compared with other types of leukemia, precise neurological evaluations and suitable treatment should be performed immediately, when APL patients with CR manifest some neurological symptoms.
Full Text of this Article in Japanese PDF (413K)

(CLINICA NEUROL, 56: 273|276, 2016)
key words: acute promyelocytic leukemia, central nervous system relapse, all-trans retinoic acid

(Received: 19-Oct-15)