Acute tetraparesis revealing acute lymphoblastic leukemia relapse: A case report and literature review

Abstract

Acute lymphoblastic leukemia (ALL) is the most common cancer of childhood. While some 5 to 8% of ALL cases will have neu rological involvement at initial presentation, up to 30% of relapses have neurological manifestations. We present the case of a pediatric ALL with meningo-radiculoneuropathy revealing a relapse while on maintenance therapy. Our patient presented the Philadelphia mutation, that is the t(9;22), and thus was at high risk of neurological involvement. The diagnosis of relapse was based on neuroimaging and CSF study. Treatment entailed modified Hyper CVAD chemotherapy with repeated intrathe cal treatment until CSF clearance. Outcome was favorable with gradual regression of neurological symptoms.