A Case of Relapsed Chronic Myeloid Leukemia Admitted with the Complaints of Paraplegia and Urinary Incontinence

Abstract

Chronic myeloid leukemia (CML) is a clonal hematopoietic stem cell malignancy. In CML, extramedullary blastic crisis is a very rare condition in which the prognosis is even worse. Herein we presented a rare case of relapsed CML patient as blastic crisis with serious neurological symptoms because of central nervous system (CNS) infiltration. A 69-year-old male patient diagnosed with CML was admitted to hospital with complaints of weakness in legs, urinary incontinence, abnormal speech, and impaired vision. Deep tendon reflexes were bilaterally hypoactive in lower and upper extremities and Babinski reflex was negative. Immunophenotyping and cytological examination of CSF showed blastic cell infiltration. Also BCR-ABL mutation was positive in CSF and MR showed CNS involvement. So the patient diagnosed as “Myeloid blastic phase of CML with CNS involvement”. Imatinib therapy was replaced with dasatinib and intrathecal methotrexate, cytarabine and dexamethasone treatment was applied. Complaints of weakness, fatigue, urinary incontinence, leg weakness and inability to walk were completely resolved in three months. Extramedullary blastic crisis such as CNS involvement has been reported in a limited number in CML. Even if hematological and cytogenetic remission is provided, CML patients should be followed regularly. Any new clinical detail should be considered carefully and extramedullary involvement including CNS should be kept in mind.