Acute Lymphoblastic Leukemia Masquerading as Guillain-Barré Syndrome

Abstract

Introduction: Neurological manifestations of acute lymphoblastic leukemia (ALL) have been reported as cranial neuropathies or meningeal symptoms most common in children. However, ALL can rarely involve the nerve roots causing symmetrical polyradiculopathy which can present with rapid onset paralysis, mimicking Guillain-Barré Syndrome (GBS). The symmetrical polyradiculopathy can be the earliest manifestation of ALL occurring even before the hematological and systemic manifestations. Case Report: We report a case of a healthy 29-year-old man who presented with subacute bilateral lower extremity weakness and numbness preceded by a respiratory infection. He was initially treated as a suspected (GBS) but cerebrospinal fluid (CSF) findings suggested an alternative diagnosis. His prior TB exposure created a diagnostic confusion. Lumbar spine magnetic resonance imaging revealed nerve root enhancements at L4-L5 and L5-S1 that are seen in GBS and TB arachnoidids. Brain magnetic resonance imaging demonstrated bilateral distention of the optic nerve sheath complexes with CSF suggestive of intracranial hypertension. CSF revealed elevated protein, nucleated cells 2145 leukocytes/mm3, numerous atypical lymphoid cells. He was later diagnosed with ALL associated symmetrical polyradiculopathy presenting with GBS-like symptoms. Conclusion: Symmetrical polyradiculopathy is a rare complication of ALL and can be confused with acute inflammatory demyelinating polyneuropathy. ALL associated polyradiculopathy in young individuals can be clinically indistinguishable from GBS. Our case highlights that when CSF findings are atypical for GBS, ALL should be considered on the differential diagnosis in patients presenting with GBS like symptoms.

A Multicenter Cohort Study on Children Suffering from Acute Lymphoblastic Leukemia: Effects of Obesity on Mortality

“…Risk (HR) is 95% CI forecast. In addition, the Cox isolation assessment, by the age group and NCI risk level, has been adjusted to accommodate differences within the system [ 11 ].…”

Diagnostic Pitfalls in Guillain–Barré Syndrome: Case Report and Literature Review

“…Moreover, given our knowledge of cases in which symmetrical polyradiculopathy was an early manifestation of acute lymphoblastic leukemia in children. which can occur even before the hematological and systemic signs [ 66 ], we performed a peripheral blood smear in order to rule out hematological malignancies.…”