Silent Spine as a Hidden Leukaemia: A Rare Case Report on Para-paresis Unmasking Childhood Acute Lymphoblastic Leukaemia (ALL)

Abstract

Acute Lymphoblastic leukaemia (ALL) remains the most commonly encountered paediatric malignancy and has a good prognosis. It’s imperative for clinicians to be aware of its unusual presentations. In this article, we present a three-year-old girl who presented with paraparesis, subsequently diagnosed to be a case of B-cell ALL, successfully treated with chemotherapy. By excluding all other causes, the neurological diagnosis of non-compressive myelopathy due to paraneoplastic syndrome was considered. The child was successfully treated with standard chemotherapy protocol, which led to both neurological improvement and haematological remission. Other unusual presentations are cranial nerve palsy, seizure, meningitis-like episode, initially presents as a primary neurological disease. Others may present as joint swelling, persistent limb pain, abdominal pain, pancreatitis, mediastinal mass, skin lesions. This case emphasises the importance of including ALL in the differential diagnosis of unexplained pediatric paraparesis.