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A Harbinger of Acute Leukemia in Relapse

Andrew Lekos, MD; M. Bashar Katirji, MD; Mark L. Cohen, MD; Russell Weisman, Jr, MD; Sami I. Harik, MD

Arch Neurol. 1994;51(6):618-622.

Abstract
Objective
To report the findings in a patient who developed severe mononeuritis multiplex in the setting of hematologic remission from acute myeloid leukemia.

Design
Single case report of the patient, hospital course, and autopsy findings.

Patient
A 63-year-old woman with a history of acute myeloid leukemia in hematologic remission experienced a succession of acute clinical neuropathies (left median, right radial, and left sciatica) several months before hematologic relapse of leukemia. Electrophysiologic tests localized the abnormalities of the left median and right radial nerves to the arms, and a magnetic resonance imaging scan of the right arm revealed focal swelling of the radial nerve proximal to the elbow. The patient refused treatment for leukemic relapse and died about 6 months after the onset of the neuropathies. An autopsy revealed leukemic infiltrates in multiple nerves without appreciable involvement of the cauda equina or many of the proximal nerves.

Conclusion
Mononeuritis multiplex, without polyradiculopathy or diffuse peripheral neuropathy, can be a presenting feature of leukemia.

Author Affiliations
From the Departments of Neurology (Drs Lekos, Katirji, and Harik), Pathology (Dr Cohen), and Medicine (Dr Weisman), University Hospitals of Cleveland (Ohio) and Case Western Reserve University School of Medicine. Dr Lekos is now with the Department of Neurosciences, Brown University, Memorial Hospital, Pawtucket, RI.