Rare Presentation of a Common Hematological Malignancy

Abstract

Background: Metastatic spinal cord compression (MSCC) is a well-recognized complication of underlying malignancies; however, MSCC is rarely seen in acute leukemia. Case Report: A 24-year-old female presented with low backache, right lower limb radicular pain, right foot drop, and loss of bladder sensation, suggestive of cauda conus syndrome. Magnetic resonance images revealed an enhanced pre-/paravertebral lesion extending from the L5-S3 level with destruction of the vertebral body and intraspinal infiltration. A peripheral blood smear revealed atypical cells, which bone marrow analysis confirmed to be vacuolated myeloblasts. A diagnosis was made of acute myeloid leukemia (AML) type M4 with spinal myeloid sarcoma leading to cord compression. A cytarabine and doxorubicin-based chemotherapy regimen was initiated. Her symptoms improved after 2 cycles, however, she developed febrile neutropenia after 4 cycles of treatment and died. Conclusion: MSCC, although rare, can be a presenting complaint of AML resulting from cord compression due to spinal myeloid sarcoma.