Case report: Bilateral facial palsy in pediatric acute lymphoblastic leukemia with central nervous system relapse.
Keywords:
Leukemia, Facial Nerve, Facial Paralysis, PediatricsAbstract
Objective: To report the youngest case of a bilateral facial palsy secondary to a central nervous system relapse from acute lymphoblastic leukemia in a female young patient that was treated with intrathecal chemotherapy, systemic corticosteroids, and physical therapy with successful outcomes.
Design: A case report of a 9-years old female patient with bilateral facial palsy.
Results: A 9-years old patient with acute lymphoblastic leukemia presented with a complete right facial nerve palsy that progresses 10 days later to a simultaneous grade IV House-Brackmann left facial nerve palsy. Neuroimaging showed basal pachymeningeal and bilateral facial nerve enhancement, predominantly in the right side. Central nervous system metastasis was confirmed with cerebrospinal fluid cytometry and medical therapy was initiated with intrathecal chemotherapy, systemic corticosteroids, and physical therapy. Three weeks after the onset of treatment, both facial palsies ameliorated to a grade IV and III, left and right facial palsy, respectively.
Conclusion: Central nervous system metastasis must be considered as a differential diagnosis of simultaneous bilateral facial palsy is presented. Early treatment with intrathecal chemotherapy, systemic corticosteroids and physical therapy may improve patients’ outcomes.
References
Gaudin RA, Jowett N, Banks CA, et al. Bilateral facial paralysis: a 13-year experience. Plast Reconstr Surg 2016;138(4):879–87.
Jung J, Park DC, Jung SY, Park MJ, Kim SH, Yeo SG. Bilateral facial palsy. Acta Otolaryngol. 2019 Oct;139(10):934-938.
Lenk L, Alsadeq A, Schewe DM. Involvement of the central nervous system in acute lymphoblastic leukemia: opinions on molecular mechanisms and clinical implications based on
recent data. Cancer Metastasis Rev. 2020 Mar;39(1):173-187.
Lakhotia M, Pahadiya HR, Kumar H, Singh J, Prajapati GR, Sangappa JR. Bilateral Facial Palsy a rare presenting symptom of acute lymphoblastic leukemia with CNS and BM Relapses. J Neurosci Rural Pract. 2015 Oct- Dec;6(4):630-2.
Smith V, Traquina DN. Pediatric bilateral facial paralysis. Laryngoscope. 1998 Apr;108(4 Pt 1):519-23.
Alsadeq A, Schewe DM. Acute lymphoblastic leukemia of the central nervous system: on the
role of PBX1. Haematologica. 2017Apr;102(4):6 11-613.
Long CM, Kerschner JE. Parotid mass: Epstein- Barr virus and facial paralysis. Int J Pediatr Otorhinolaryngol 2001;59(2):143-6.
Leclercq M, Sauvêtre G, Levesque H, Marie I. Paralysie faciale à bascule révélatrice d'une
infection à Human T-lymphotropic virus type 1 (HTLV-1) [Recurrent facial palsy revealing
Human T-lymphotropic virus type 1 (HTLV-1) infection]. Rev Med Interne. 2015Oct;36(10):70 1-5.
Zhou F, Wen Y, Jin R, Chen H. New attempts for central nervous infiltration of pediatric acutte lymphoblastic leukemia. Cancer Metastasis Rev. 2019 Dec;38(4):657-671.
Sung SH, Jang IS. Isolated Central Nervous System Relapse of Acute Lymphoblastic
Leukemia. Brain Tumor Res Treat 2014;2(2):1 14-118.
Jeha S, Coustan-Smith E, Pei D, Sandlund JT, Rubnitz JE, Howard SC, et al. Impact of tyrosine kinase inhibitors on minimal residual disease and outcome in childhood Philadelphia chromosome-positive acute lymphoblastic leukemia. Cancer. 2014 May 15;120(10):1514-9.
Hsieh YT, Gang EJ, Shishido SN, Kim HN, Pham J, Khazal S, Osborne A, Esguerra ZA, Kwok E, Jang J, Bonig H, Biediger RJ, Vanderslice P, Kim YM. Effects of the smallmolecule inhibitor of integrin α4, TBC3486, on pre-B-ALL cells. Leukemia. 2014 Oct;28 (10):2101-4.
Kim SJ, Lee HY. Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature. J Korean Med Sci. 2020 Aug 3;35(30):e245.
Roy M, Corkum JP, Shah PS, Borschel GH, Ho ES, Zuker RM, et al. Effectiveness and safety of the use of gracilis muscle for dynamic smile restoration in facial paralysis: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2019;72(8):1254-64.
