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An unusual headache: CSF negative APML relapse in the brain
Thomas Quinn1, Manish Jain2, Ming-Te Lee2
1Department of Neurology, Leeds Teaching Hospitals Trust, Leeds, UK.
Oxford Medical Case Reports
|September 30, 2020
Summary
Acute Promyelocytic Leukaemia (APML) can rarely affect the central nervous system. This case highlights a diagnostic challenge in a patient with APML presenting with a brain tumor, emphasizing the need for high suspicion.
Area of Science:
- Hematology
- Neuro-oncology
- Oncology
Background:
- Acute Promyelocytic Leukaemia (APML) is a distinct subtype of Acute Myeloid Leukaemia (AML).
- Extra medullary disease (EMD) is uncommon in APML, but CNS involvement is a recognized manifestation.
- Post-therapy surveillance is crucial for detecting relapse or complications.
Observation:
- A middle-aged male patient undergoing surveillance for APML presented with a headache.
- Initial investigations, including CT brain imaging and CSF analysis, were non-diagnostic.
- A brain tumor composed of APML cells was ultimately identified.
Findings:
- The case presented a diagnostic challenge due to the subtle initial imaging findings.
- Cerebrospinal fluid analysis did not initially reveal malignant cells.
- APML cells were confirmed as the cause of the intracranial lesion.
Implications:
- This case underscores the importance of a high index of suspicion for CNS involvement in APML patients with new neurological symptoms.
- Diagnostic delays can be minimized by prompt and thorough neurological evaluation.
- Awareness of rare EMD presentations in APML is critical for timely diagnosis and management.
