TY - JOUR
T1 - Clinical Problem-Solving
T2 - Lower Extremity Weakness & Paresthesia in an Immunocompromised Patient With a Complex Cancer History
AU - Stamm, Brian
AU - Yu, Margaret
AU - Adrissi, Jennifer
AU - Brooker, Sarah M.
AU - Hac, Nicholas E.F.
AU - Priyadarshini, Shubadra
AU - Dixit, Karan
N1 - Funding Information:
Informed consent was obtained from the patient for publication of this case. The author(s) received no financial support for the research, authorship, and/or publication of this article.
Publisher Copyright:
© The Author(s) 2021.
PY - 2022/1
Y1 - 2022/1
N2 - We present a case of new onset bilateral lower extremity weakness, paresthesia, urinary retention and bowel incontinence in a 51-year-old man. He had a complicated history of acute myelogenous leukemia with known central nervous system (CNS) and leptomeningeal involvement status post allogenic stem cell transplant complicated by chronic graft versus host disease (GVHD). We review the differential diagnosis as the physical exam and diagnostic results evolved. We also provide a review of the relevant literature supporting our favored diagnosis, as well as other competing diagnoses in this complicated case. The ultimate differential diagnosis included viral myelitis, treatment-related myelopathies, and CNS GVHD. The case provides a sobering reminder that even with an appropriate diagnostic workup, some cases remain refractory to therapeutic efforts. It also underscores the importance of a sensitive neurologic exam, given the significant clinico-radiological delay, and reviews the complex differential diagnosis for myelopathy.
AB - We present a case of new onset bilateral lower extremity weakness, paresthesia, urinary retention and bowel incontinence in a 51-year-old man. He had a complicated history of acute myelogenous leukemia with known central nervous system (CNS) and leptomeningeal involvement status post allogenic stem cell transplant complicated by chronic graft versus host disease (GVHD). We review the differential diagnosis as the physical exam and diagnostic results evolved. We also provide a review of the relevant literature supporting our favored diagnosis, as well as other competing diagnoses in this complicated case. The ultimate differential diagnosis included viral myelitis, treatment-related myelopathies, and CNS GVHD. The case provides a sobering reminder that even with an appropriate diagnostic workup, some cases remain refractory to therapeutic efforts. It also underscores the importance of a sensitive neurologic exam, given the significant clinico-radiological delay, and reviews the complex differential diagnosis for myelopathy.
KW - clinical problem-solving
KW - myelopathy
KW - transverse myelitis
UR - http://www.scopus.com/inward/record.url?scp=85105914195&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85105914195&partnerID=8YFLogxK
U2 - 10.1177/19418744211017396
DO - 10.1177/19418744211017396
M3 - Article
C2 - 34950411
AN - SCOPUS:85105914195
SN - 1941-8744
VL - 12
SP - 183
EP - 187
JO - The Neurohospitalist
JF - The Neurohospitalist
IS - 1
ER -