Critical illness polyneuropathy: a rare but serious adverse event in pediatric oncology

Area of Science:

• Pediatric Neurology
• Oncology
• Critical Care Medicine

Background:

• Critical illness polyneuropathy (CIP) is a serious complication in critically ill patients, particularly those with sepsis and multiorgan dysfunction.
• Pediatric oncology patients with acute leukemia are susceptible to neurological complications, including CIP, which can manifest as quadriparesis and prolonged mechanical ventilation dependence.

Observation:

• This report details an adolescent with T-cell acute lymphoblastic leukemia who developed CIP after sepsis requiring mechanical ventilation and catecholamine support.
• The patient presented with quadriparesis and significant challenges in weaning from mechanical ventilation, indicative of severe neuromuscular compromise.

Findings:

• The clinical presentation of quadriparesis and difficult weaning strongly suggested CIP in the context of sepsis and underlying leukemia.
• Differential diagnoses considered included vincristine-induced polyneuropathy, anterior lumbosacral radiculopathy (ALR), Guillain-Barré syndrome, and chronic inflammatory demyelinating polyneuropathy, all relevant in pediatric leukemia patients.

Implications:

• Early recognition and diagnosis of CIP are crucial for appropriate management in pediatric oncology patients with sepsis.
• Understanding the differential diagnoses aids in distinguishing CIP from other neuropathies, guiding treatment strategies and improving patient outcomes.
• This case underscores the importance of considering CIP in pediatric cancer patients experiencing unexplained neuromuscular weakness during critical illness.