Mononeuritis Multiplex as an early sign of relapse leukemia

• Main Authors: Zainulabid, Ummu Afeera, Kori, Ahlam Naila
• Format: Conference or Workshop Item
• Language: English; English
• Published: 2017
• Subjects: RC Internal medicine; RC633 Specialties of Internal Medicines- Diseases of The Blood and Blood-forming Organs. Hematologic Diseases
• Online Access: http://irep.iium.edu.my/86427/1/afeera%20poster%202.pdf; http://irep.iium.edu.my/86427/7/Ummu%20Afeera%20Zainulabid.pdf; http://irep.iium.edu.my/86427/
• Institution: Universiti Islam Antarabangsa Malaysia

Mononeuritis multiplex is a rare presentation of relapse in a patient with background history of acute leukemia. A 29 year old gentleman with a diagnosis of T-Acute Lymphoblastic Leukemia (T-ALL) on 13th of December 2016 received GMALL I and II induction followed by HYPERCVAD A1, B1, A2 and B2 latest on 28th April 2017. His Bone Marrow Aspiration (BMA) showed morphological remission, however he was not flowed for Minimal Residual Disease (MRD). He was initially planned for allogeneic hematopoietic stem cell transplantation counselling on 31st of May 2017. Unfortunately, he presented to hematology daycare on 24th May 2017 after two private clinic visits with sudden onset of drooping of right eyelid and right sided frontal headache and periorbital pain. He denies weakness, numbness or other focal neurology. Clinically he had moneneuritis multiplex as evidenced by right third nerve palsy, complete ptosis with ophthalmoplegia. He also had left lower motor neuron facial nerve palsy. CECT brain, MRI brain and orbit were reported as normal. Lumbar puncture examination was aseptic with negative culture. CSF cytology showed acellular smear with negative latex agglutination and Indian ink tests. He was subsequently transferred to Hospital Ampang for further evaluation of T-ALL CNS relapse. His repeated full blood picture was noted to have suspicious circulating mononuclear cells seen. Repeated bone marrow aspirate showed presence of 6% small sized blasts and in correlation of flow cytometry, features are consistent of relapsed T-ALL.Physician should always include relapse of leukemia in the differential diagnosis when encountering patients presented with similar presentation in the setting of a known diagnosis of leukemia.