Abstract Details

Title Peripheral Neuropathy in a Pediatric ALL Patient

Topic Child Neurology and Developmental Neurology

Presentation(s) P14 - Poster Session 14 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-006

Objective

To describe the presentation and workup of a patient presenting with neuropathy found to have vitamin deficiency and anti-GD1a antibodies.

Background

Peripheral neuropathy is a common finding in children with leukemia, particularly those treated with vincristine. Patients typically present with paresthesia, hyporeflexia, and weakness, often in a distal to proximal gradient. In patients receiving vincristine, symptoms typically improve within several months of stopping therapy.

Design/Methods Not applicable.

Results We present a case of a 13-year-old male from Qatar who has a history of T-cell acute lymphoblastic leukemia (T-ALL), diagnosed one year prior to presentation as well as 50lb weight loss over the past 6 months. He was admitted for cycle 3 of maintenance therapy with vincristine, prednisone, and intrathecal methotrexate. At time of admission, he reported diffuse weakness and was only able to ambulate a few steps. However, on day 7 of admission he developed complete inability to bear weight or turn in bed as well as diffuse neuropathic pain despite last vincristine dose being 6 weeks prior. Exam was notable for diffuse weakness, worse proximally and absent reflexes. Nerve conduction studies showed decreased velocity with signs of conduction block in multiple nerves suggestive of a diffuse demyelinating pathology. MRI showed no pathologic enhancement and CSF protein was normal. However, laboratory workup was notable for positive anti-GD1a antibodies as well as low levels of B1 and B6. He was started on treatment with IVIG and subsequently plasmapheresis as well as B1 and B6 supplementation.

Conclusions

This case illustrates the need to consider a broad range of etiologies including vitamin deficiencies and immune mediated neuropathy when evaluating neuropathy in pediatric leukemia patients despite high prevalence of medication-induced neuropathy in this population.

Authors/Disclosures
Douglas A. Wells, Jr., MD (Baylor College of Medicine) PRESENTER	Dr. Wells has nothing to disclose.
Jeffrey Kuerbitz, PhD (Baylor Child Neurology)	Dr. Kuerbitz has nothing to disclose.
Kristen Fisher, DO (Baylor College of Medicine)	Dr. Fisher has nothing to disclose.

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