Chronic Lymphocytic Leukaemia: Rare Involvement of the Central Nervous System

  • Carolina Amado Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Valter Duarte Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Mariana Silva Leal Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Margarida Cruz Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Gisela Ferreira Haematology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal

Keywords

Chronic lymphocytic leukaemia, central nervous system

Abstract

Involvement of the central nervous system, although uncommon, is one of the most frequent extramedullary manifestations of chronic lymphocytic leukaemia (CLL). Various conditions can lead to neurological symptoms in CLL patients and distinguishing between clinically significant CLL involvement of the CNS and other aetiologies can be challenging.
The authors report the case of a 90-year-old woman with a previous diagnosis of low-risk CLL who presented to the emergency room with altered mental status. After the most frequent causes were ruled out and considering the underlying disease, CNS infiltration by clonal B-cells was hypothesised and later confirmed. Treatment was initiated, but the patient died soon afterwards.

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References

  • Eichhorst B, Robak T, Montserrat E, Ghia P, Niemann CU, Kater AP, et al. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment, and follow-up. Ann Oncol 2020;32(1):23–33.
  • Strati P, Uhm Joon H, Kaufmann TJ, Nabhan C, Parikh SA, Hanson CA, et al. Prevalence and characteristics of central nervous system involvement by chronic lymphocytic leukemia. Haematologica 2016;101(4):458–465.
  • Nakanishi T, Ito T, Fujita S, Satake A, Konishi A, Hotta M, et al. Refractory chronic lymphocytic leukemia with central nervous system involvement: a case report with literature review. J Blood Med 2020;11:487–502.
  • Abdulrahman A, Wajda A, Peyman S, Lauren M, Seema N, Abdulrazag A. Central nervous system lymphoma in a patient with chronic lymphocytic leukemia: a case report and literature review.Cureus 2018;10(11):e3660.
  • Mihaljevic B, Smiljanic M, Antic D, Kurtovic ND, Balint MT. Chronic lymphocytic leukemia involvement of central nervous system: clinical diversity, diagnostic algorithm and therapeutic challenges. Ann Indian Acad Neurol 2018;21(1):85–87.
  • Timmers NKLM, de Maar JS, van Kruijsdujk RCM, Klein SK. Central nervous system localisation of chronic lymphocytic leukaemia, description of two very distinct cases and a review of the literature. Ann Hematol 2018;97:1627–1632.
  • Wanquet A, Birsen R, Bonnet C, Boubaya M, Choquet S, Dupuis J, et al. Management of central nervous system involvement in chronic lymphocytic leukaemia: a retrospective cohort of 30 patients. Br J Haematol 2017;176(1):37–49.
  • Hna JH, Wilber ST. Altered mental status in older emergency department patients. Clin Geriatr Med 2013;29(1):101–136.
  • Taylor JW, Flanagan EP, O’Neil BP, Siegal T, Omuro A, DeAngelis L, et al. Primary leptomeningeal lymphoma. Neurology 2013;81:1690–1696.
  • Pinto AL, Ferreira G, Carda JP, Gomes M, Ribeiro ML. Isolated Ritcher’s syndrome of the brain: diagnosis in the eye of the beholder. Ann Hematol 2018;97(8):1509–1511.
  • Published: 2021-11-02

    Issue: 2021: LATEST ONLINE (view)

    Section: Articles

    How to cite:
    1.
    Amado C, Duarte V, Silva Leal M, Cruz M, Ferreira G. Chronic Lymphocytic Leukaemia: Rare Involvement of the Central Nervous System. EJCRIM 2021;2 doi:10.12890/2021_002847.

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