Chronic meningitis in acute promyelocytic leukemia [a case report]

ABSTRACT

The occurrence of extramedullary disease [EMD] at presentation or at relapse has long been considered a rare event in Acute Promyelocytic Leukemia [APL]. Our purpose from recent reports of EMD at presenting in APL have raised increasing concern about one of causes of chronic meningitis. This study describe a case of acute promyelocytic leukemia [APL] in 25 years old female patient admitted in Emam Reza hospital, presenting with severe headache and vomiting and showed signs of meningeal irritation as well as papilledema. Cytocentrifuge examination of CSF showed an excess of promylocytes, but peripheral blood didn't show any abnormal cell or blasts where as BMA showed increase of promyelocyte with multiple auer rod. After 2 weeks of aleukemic phase, this patient developed hematologic picture of APL diagnosed myeloid origin cells with myelopperoxidase stain. She was diagnosed as having leukemic meningitis and after 3 weeks in spite of chemotherapy, she dead Leukemic relapse or first presentation of leukemia may be the etiology of aseptic meningitis. Rarely central nervous. system leukemia and leukemic meningitis are associated with normal bone marrow and sometimes patients at Aleukemic phase present with meningitis. therefore we suggested that in patients with aseptic meningitis cerebrospinal fluid cytospine smear should be evaluated for neoplasic and leukemic cells