204 - Substantial Functional Recovery in a Patient with Carcinomatous Meningitis Secondary to ALL: A Case Report

This case of CNS relapse in adult ALL is notable for its atypical presentation, diagnostic complexity, and significant functional improvement following prompt intervention. Unlike more commonly reported manifestations of CNS leukemia, such as cranial neuropathies, encephalopathy, or meningeal signs, this patient presented with progressive bilateral lower extremity weakness and radiculopathy, leading to recurrent falls. In the setting of a post-allogeneic transplant patient, this presentation initially raised concern for alternative diagnoses, including medication-induced myopathy (belumosudil, steroids), arachnoiditis, and GVHD-related neuromuscular disease.

What further distinguishes this case is the early functional improvements despite severe neurologic involvement. Prompt Ommaya reservoir placement, intrathecal chemotherapy, and admission to acute rehabilitation led to substantial improvements in strength, coordination, and functional independence.

Conclusions: This case illustrates a rare and diagnostically challenging presentation of CNS relapse in adult ALL. In post-transplant patients where immunosuppression, medication side effects, and GVHD complicate the diagnosis, a high index of suspicion for leukemic relapse is essential. With prompt diagnosis and treatment, this case highlights the importance of early recognition and multidisciplinary care in recovery.