Facial Palsy as a Presentation of Relapsed Pediatric AML

Abstract

Facial palsy is a rare manifestation of the central nervous system (CNS) involvement of pediatric leukemia, characterized by the infiltration of leukemic cells in the nervous system. We report clinical presentation, treatment, and outcomes of two cases of relapsed AML presenting facial palsy. Two patients (10-year-old girl and 2-year-old boy) presented facial palsy, lower motor neuron type, at 4 and 1 months after completing acute myeloid leukemia (AML) treatment. The initial diagnosis was AML, M 0 and M 5, respectively, without CNS involvement and in remission after 4 courses of intensive chemotherapy. Isolated CNS relapse was revealed by CSF cytology. Treatment was started with re-induced systemic chemotherapy, intrathecal chemotherapy comprising cytarabine, hydrocortisone and methotrexate with craniospinal irradiation. Subsequently, both had bone marrow relapse at 3 and 2 months, respectively, after CNS relapse and died from the disease.