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Encephalomyelitis associated with leukemia in a child
J B Gregorios1, E Roldan, J Davis
1Department of Pathology, University of Miami--Jackson Memorial Hospital, FL.
Insights
A rare case of encephalomyelitis in a child with acute lymphoblastic leukemia (ALL) is presented. This neurological disorder, typically seen in adults, occurred after cancer treatment, highlighting its importance in pediatric differential diagnoses.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Leukemia Research
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Neurological complications can arise during or after ALL treatment.
- Paraneoplastic encephalomyelitis is a recognized neurological complication in adults with malignancy.
Observation:
- A 5-year-old boy with ALL developed seizures, confusion, and coma post-radiation and intrathecal methotrexate therapy.
- Brain CT revealed bilateral hypodensities in the posterior parietal and temporal regions.
- Autopsy showed perivascular inflammation, microglial nodules, and necrosis in the brain and spinal cord.
Findings:
- The observed neuropathological findings were consistent with encephalomyelitis.
- No intranuclear viral inclusions were identified, ruling out common viral causes.
- The presentation suggests a paraneoplastic or treatment-related encephalomyelitis in a pediatric leukemia patient.
Implications:
- This case expands the understanding of neurological disorders in pediatric ALL.
- It emphasizes the need to consider paraneoplastic encephalomyelitis in the differential diagnosis of children with ALL and neurological symptoms.
- Early recognition and diagnosis are crucial for appropriate management of these complex cases.
Abstract:
A case of an encephalomyelitis in a child with acute lymphoblastic leukemia is reported. The patient was a 5-year-old boy who developed seizures, progressive confusion, and coma after radiation and intrathecal methotrexate therapy. Computed tomography (CT) of the brain showed bilateral hypodensities in the posterior parietal and temporal regions. At autopsy, perivascular inflammation, microglial nodules without intranuclear viral inclusions, and bilateral necrosis of the temporoparietal and hippocampal regions were seen in the brain and spinal cord. Paraneoplastic encephalomyelitis is generally recognized in adult patients with underlying malignancy but, to our knowledge, has not been reported in children with leukemia. This report should alert the clinicians to an entity that must be included in the differential diagnosis of leukemic children with progressive neurologic disorder.