Pediatric Paraneoplastic Necrotizing Encephalitis Associated With Acute Lymphoblastic Leukemia

Area of Science:

• Neurology
• Pediatric Oncology

Background:

• Paraneoplastic encephalitis presents as a diverse group of neurological disorders.
• These conditions are often associated with various pediatric tumor types.

Observation:

• A seven-year-old boy experienced acute neurological symptoms including weakness, seizure-like activity, and agitation.
• Initial evaluations suggested viral encephalitis, but he was later diagnosed with precursor B-cell acute lymphoblastic leukemia.
• Recurrent encephalopathy occurred before chemotherapy, with MRI revealing diffuse necrotizing encephalitis.

Findings:

• The patient received chemotherapy, intravenous immunoglobulin, and plasmapheresis.
• Neurological status improved, and MRI abnormalities resolved.
• Six years post-treatment, the patient remains in remission for leukemia with minimal neurocognitive deficits and mild hemiparesis.

Implications:

• This case highlights the first reported instance of paraneoplastic encephalitis associated with pediatric leukemia.
• Hematologic malignancies should be considered in the differential diagnosis of pediatric paraneoplastic encephalitis.
• Prompt recognition and management are vital for improving patient outcomes.