710 - Neuroleukemiosis presenting as multifocal peripheral neuropathy in a pediatric patient

An 11-year-old male with a complex oncologic history, including multiple relapses of ALL and therapy-associated AML requiring peripheral blood stem cell transplantation, developed progressive right upper extremity pain, weakness, and sensory loss.  

Initial evaluation excluded infection, trauma, or DVT. Further surgical exploration, neurolysis, and nerve biopsy of the right upper extremity revealed extensive scarring and necrosis of the right median and ulnar nerves, with histopathological evidence of myeloid sarcoma infiltrating both nerves. Subsequent EMG showed severe axonal damage to the right median and ulnar nerves starting in the mid-arm. The patient further developed progressive pain and weakness in the left hand and foot. MRI of the upper and lower extremities demonstrated multifocal peripheral nerve involvement, consistent with neuroleukemiosis, while brain MRI revealed leptomeningeal involvement.

The patient underwent oncologic treatment with chemotherapy and radiotherapy, with regular involvement from PM&R and therapists to assess and treat functional deficits.


Discussions:

Neuroleukemiosis is a rare complication of pediatric leukemia, presenting as progressive neuropathy or plexopathy, impacting motor and sensory function, mobility and ADLs, and may impair overall gross and fine motor development. 

Rehabilitation plays an important role in optimizing recovery, addressing neuropathic pain, and facilitating developmental milestones, while promoting functional independence. Interventions including physical and occupational therapy, pain management (pharmacologic and non-pharmacologic), and psychosocial support are important to minimize disability and enhance quality of life, especially in pediatric patients who are still growing and developing towards age-appropriate milestones. Early rehabilitation is associated with improved functional outcomes.


Conclusions: Neuroleukomiosis in pediatric leukemia necessitates prompt diagnosis and oncologic management, though long-term neurological and functional sequelae are common. Early and sustained rehabilitation interventions are important to maximize functional independence and manage pain, which underscores the importance of interdisciplinary care in this population.