Cauda Equina Involvement in Acute Myeloid Leukemia Relapse
Jitsuda Buakhao MD*, Amarate Tansawet MD**
Affiliation : * Department of Medicine, Nopparatrajathanee Hospital, Department of Medical Services, MOPH, Thailand ** Department of Radiology, Nopparatrajathanee Hospital, Department of Medical Services, MOPH, Thailand
Although central nervous system (CNS) involvement in acute myeloid leukemia has been described in about 2 to 4%, it still represents a major therapeutic problem, particularly cauda eqina involvement that is clinically significant and unusual. Here, a 22-year-old man, with underlying AML (M2-Subtype, FAB classification) and cytogenetic analysis resulted in 45, x, -y, t(8;21) (q22;q22)[15] whose presenting symptoms of low back pain and incontinence, 10 months after first remission, was reported. This was followed by peripheral and bone marrow relapse. The magnetic resonance image (MRI) findings revealed leukemic infiltration at S1-S5 of the spinal cord canal with associated soft tissue component at presacral area encasing bilateral S1-S5 exiting root with heterogeneous enhancement in bone marrow of S2-S4. The therapeutic and prognosis implications of spinal cord involvement by leukemia were discussed. Because of severe morbidity, the patient developed bone marrow failure and died from sepsis.
Keywords : Cauda equina involvement, Acute myeloid leukemia, Relapse
