Recurrence of chronic lymphatic leukemia as infiltration of the spinal cord.

Recurrence of chronic lymphatic leukemia as infiltration of the spinal cord.

Central nervous system (CNS) involvement in chronic lymphocytic leukemia (CLL) is rare, and spinal cord infiltration as a presenting manifestation has only rarely been described. We present the case of a 65-year-old man with CLL, initially diagnosed at the age of 54, who had not received prior treatment. He presented with a six-week history of thoracic and epigastric pressure. Mild ataxia was found in the clinical exam. Clinical evaluation revealed leukocytosis (163 G/L; normal range: 4-10 G/L). MRI of the spine showed a mildly enhancing, T2 hyperintense central lesion extending between C3 and T8. There was a pleocytosis of 105 /micro/l consisting of neoplastic B-lymphocytes. The bone marrow biopsy diagnosed a relapse of CLL, and the patient was started on ibrutinib, which had a positive effect. This case highlights spinal cord infiltration as a rare initial manifestation of CLL relapse, presenting with non-specific symptoms such as thoracic and epigastric pressure and mild spinal ataxia.