Longitudinally extensive transverse myelitis as a rare paraneoplastic presentation in chronic myelogenous leukemia

Abstract Background Paraneoplastic syndromes are clinical syndromes involving nonmetastatic systemic effects that accompany malignant disease. It is estimated that up to 8% of patients with cancer are affected by paraneoplastic syndromes. We present a rare neurologic paraneoplastic syndrome in chronic myeloid leukemia (CML). Case report A 51-year-old Filipino male, farmer, presented with a 6-month history of malaise, abdominal enlargement, and a left upper quadrant mass. Four months later, he developed vague low back pain with sudden onset paresthesias on both soles, rapidly progressing over 24 hours to include numbness and weakness of both lower extremities with urinary retention and bowel incontinence. Physical examination revealed massive splenomegaly and a complete cord syndrome with last normal sensory level at T7. Bone marrow studies were consistent with a myeloproliferative neoplasm with 74.73% BCR/ABL fusion genes – diagnostic of CML . Magnetic resonance imaging of the spine showed an abnormal T1W1/T2W1 bright signal at the central aspect of the spinal canal from T8 to T12 causing expansion of the cord. No gross masses were seen ruling out a compressive myelopathy. Cerebrospinal fluid analysis showed an acellular fluid with elevated immunoglobulin G with no malignant cells seen. These findings were consistent with longitudinally extensive transverse myelitis (LETM). Methylprednisolone pulse therapy was still offered to salvage any residual function. No immediate neurologic improvement was observed. Discussion and summary Transverse myelitis is described as spinal cord dysfunction causing paresis with sensory and autonomic impairment below a clearly defined level. It is often associated with neuromyelitis optica and multiple sclerosis. In the absence of antibody serology testing, correlation with clinical presentation may favor a specific etiology. Paraneoplastic myelitis is commonly seen in lymphoid, rather than myeloid malignancies. There are twelve case reports on paraneoplastic syndromes in CML. To our knowledge, this is the first reported case of LETM in CML.