Progressive necrotizing myelopathy associated with leukemia: clinical, pathologic, and MRI correlation

Area of Science:

• Neurology
• Hematology
• Oncology

Background:

• Leukemia can present with diverse neurological complications.
• Necrotizing myelopathy is a severe, often irreversible spinal cord condition.
• Paraneoplastic syndromes occur when cancer triggers immune responses affecting the nervous system.

Observation:

• A patient with myelomonocytic leukemia developed progressive, necrotizing myelopathy.
• Neuropathology revealed diffuse spinal cord necrosis, predominantly in the cervical region.
• Magnetic resonance imaging (MRI) showed characteristic T2 signal hyperintensities in affected areas.

Findings:

• No direct link was found between antileukemic treatments and the myelopathy.
• No other infectious or systemic causes explained the spinal cord lesions.
• The findings support a paraneoplastic etiology for the myelopathy.

Implications:

• This case highlights necrotizing myelopathy as a rare neurological complication of leukemia.
• It underscores the diagnostic utility of MRI in identifying spinal cord necrosis.
• Further research is needed to understand the mechanisms of paraneoplastic myelopathy in leukemia.