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General Rehabilitation

(Kiosk 1) Atypical Appearance of AML; Paraplegia Due to Direct Leukemic Infiltration of the Nerve Roots

Friday, November 17, 2023
8:00 AM – 9:15 AM CT

    Primary Author(s)

  • Joseph A. Aguirre, DO

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

    • Co-Author(s)

  • Leslie Rydberg, MD

    Attending
    McGaw MC of NW University NW Med Schl/RIC
    Chicago, Illinois

Case Diagnosis: 73 year old female with new onset bilateral lower extremity (LE) numbness and weakness in the setting of acute myeloid leukemia (AML).

Case Description or Program Description: A 73-year-old female with a history of AML (status post stem cell transplant in 2020) presented with ongoing bilateral lower extremity (LE) numbness and weakness. She was also noted to have intermittent urinary retention and bowel incontinence. MRI was suspicious for leukemic infiltration of the nerve roots starting at L3. She was seen by her oncologist and treated with radiation to sacral plexus, intrathecal (IT) chemotherapy and one cycle of venetoclax and azacitidine. The patient was previously ambulatory at home with assistance of a walker, but then began to experience progressive weakness that required assistance of 1-2 people for ambulation. She was admitted to IPR at a max assist level for transfers and sit to stand.

Setting: Inpatient Rehabilitation (IPR)

Assessment/Results: Inpatient therapies were aimed at impairments of decreased strength, balance and endurance. Treatment was also aimed at bladder and bowel training. With intensive IPR , the patient ultimately discharged home at a supervision level for transfers and partial assistance for sit to stand. On discharge, the patient was also voiding spontaneously without use of intermittent catheterization.

Discussion (relevance): Leukemic infiltration is a rare complication seen in AML and has only been described in a few case reports. Treatment typically includes IT chemotherapy and systemic chemotherapy. This case highlights the value of IPR to address impairments and disabilities to help patients get back to prior level of function.

Conclusions: This case presents a rare cause of paraplegia due to direct leukemic infiltration of the nerve roots. The case shows that even with unique presentations, common rehabilitation techniques used during IPR allowed this patient to return home safely.