Primary plasma cell leukemia presented as progressive paraplegia: a case report

Area of Science:

• Hematology
• Oncology
• Neurology

Background:

• Plasma cell leukemia (PCL) is a rare, aggressive hematologic malignancy.
• It represents the leukemic phase of multiple myeloma.
• Atypical presentations of PCL can pose diagnostic challenges.

Observation:

• A 52-year-old male presented with progressive paraparesis, leading to paraplegia.
• Spinal MRI revealed an extradural mass causing significant cord compression and multiple bony erosions.
• Peripheral blood and bone marrow examinations identified numerous plasmablasts.

Findings:

• Immunochemical studies confirmed atypical cells expressing lambda light chains, CD45, and CD38.
• The patient was diagnosed with primary plasma cell leukemia based on these findings.

Implications:

• This case represents the first reported instance of primary PCL presenting with progressive paraplegia.
• Highlights the importance of considering PCL in the differential diagnosis of spinal cord compression, even with atypical presentations.
• Underscores the need for thorough hematologic and oncologic evaluation in patients with unexplained neurological deficits and bone lesions.