Acute myelogenous leukemia presenting as facial nerve palsy. A case report

doi:10.1016/S0165-5876(86)80056-8

International Journal of Pediatric Otorhinolaryngology

Volume 12, Issue 1, November 1986, Pages 49-53

https://doi.org/10.1016/S0165-5876(86)80056-8 Get rights and content

Summary

A case is presented of a 5.5-year-old girl admitted with acute mastoiditis and facial nerve palsy. The final diagnosis of leukemic infiltration of the mastoid bone, middle ear and VIIth cranial nerve was made only after surgery and histological examination. Similar cases described in the English literature are reviewed and treatment is discussed. Chemotherapy or combined chemo- and radiotherapy are the treatment of choice in known leukemic patients without symptoms of superimposed infection of the ear or the mastoid process. Surgical management is restricted to cases in which tissue for histological diagnosis is required or drainage of acute infection is needed.

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Cited by (24)

Burkitt's leukemia with temporal infiltration presenting as acute mastoiditis in a 7-month-old child
2013, Archives de Pediatrie
Nous rapportons le cas d’une enfant de 7 mois présentant une mastoïdite aiguë avec otorrhée gauche. L’hémogramme avait mis en évidence une hyperleucocytose à 79 000/mm³. Un Streptococcus pneumoniae avait été isolé dans les prélèvements bactériologiques réalisés lors du drainage de l’abcès mastoïdien. Le frottis sanguin avait révélé la présence de cellules blastiques circulantes et l’os mastoïdien prélevé lors de l’intervention était infiltré par des cellules blastiques. Le diagnostic de leucémie de Burkitt avec localisation et lyse osseuse temporale gauche avait donc été posé. Un traitement selon le protocole LMB (Lymphome Malin B), (2001) de la Société française d’oncologie pédiatrique avait permis une rémission clinique et paraclinique sans rechute 30 mois après son arrêt. Le scanner de contrôle était normal avec restitution ad integrum du rocher gauche. Toute mastoïdite aiguë atypique dans sa présentation ou son évolution doit faire rechercher une affection sous-jacente de type hémopathie maligne, histiocytose ou tumeur solide. Une affection otitique peut être le mode de révélation d’une leucémie aiguë. À notre connaissance, il n’existe pas de cas de leucémie de Burkitt avec atteinte lytique temporale mastoïdienne rapporté dans la littérature chez un enfant de moins de 1 an.
A 7-month-old girl presented with left acute mastoiditis and a white blood cell count of 79,000/mm³. A surgically obtained bacteriological sample showed Streptococcus pneumoniae. Direct blood examination revealed leukemic blast cells. Histological samples showed leukemic infiltration of the left temporal bone. The final diagnosis was Burkitt's leukemia with left temporal bone leukemic infiltration. The patient received chemotherapy according to the LMB 2001 protocol from the Société française d’oncologie pédiatrique. Clinical, biological, and imaging follow-up 30 months after the end of treatment showed remission with complete recovery in the left temporal bone. Atypical presentation of acute mastoiditis (AM) should prompt investigation into whether there is a rare underlying pathology, such as a hemopathy, histiocytosis, or solid tumor. The first sign of leukemia may be acute middle ear disease. To our knowledge, no other cases of Burkitt's leukemia with temporal bone leukemic infiltration presenting as AM have been reported in a child under 1 year of age.
Acute myelogenous leukemia presenting as atypical mastoiditis
2012, International Journal of Pediatric Otorhinolaryngology Extra
Citation Excerpt :
Surgical interventions have been described with granulocytic sarcoma (Table 1). Surgical findings at mastoidectomy include a green gelatinous fluid, a yellow amorphous tissue, and a tan lobulated rubber tumor, all positive fore granulocytic sarcoma [1,3,4]. Surgical intervention is not without risks.
Acute leukemia presenting as otitis media is a rare presentation of the disease [1], [2], [3], [4], [5]. We present a patient that was diagnosed with acute myelogenous leukemia (AML) who had signs and symptoms of acute otitis media and mastoiditis. His workup revealed granulocytic sarcoma involving the superior sagittal sinus, sigmoid sinus, internal jugular vein, and parotid gland. This extensive involvement of granulocytic sarcoma has not been described. This case report highlights the importance of complete hematologic and radiologic workup prior to consideration for surgical intervention for mastoiditis.
Facial Paralysis as a Presenting Symptom of Leukemia
2006, Pediatric Neurology
Facial paralysis may occur as a complication of central nervous system leukemias in children, but it is rarely a presenting symptom. This report describes an 8-month-old child who presented with peripheral facial palsy, failure to thrive, anemia, and otitis media. Antibiotic and steroid treatment led to an improvement in the clinical condition, but not the paralysis. At readmission 3 weeks later, physical examination revealed bluish, firm, palpable masses on the scalp and facial areas, and laboratory and imaging studies confirmed the diagnosis of acute myeloid leukemia. This case should alert physicians to consider hematologic malignancies in children with facial paralysis.
Bell's Palsy in Children
2003, Seminars in Pediatric Neurology
Bell’s palsy is a self-limiting idiopathic rapid onset facial palsy that is non-life-threatening and has a generally favorable prognosis. Facial paralysis can be caused by numerous conditions, all of which should be excluded before a diagnosis of Bell’s palsy is reached. The etiopathogenesis of Bell’s palsy is uncertain; acute immune demyelination triggered by a viral infection may be responsible. Controversy exists regarding treatment options. This article reviews the differential diagnosis and diagnostic and therapeutic options and discusses the controversies related to the various treatment modalities (steroids, acyclovir, and surgery). A simple practical approach to diagnosing and treating children with Bell’s palsy is suggested.
An alarming sign for serious diseases in children: Bilateral facial paralysis
2002, Pediatric Neurology
Facial paralysis in children is most often idiopathic, and isolated facial nerve palsy resulting from leukemic infiltration is a rare occurrence. We report a 13-year-old male with acute lymphoblastic leukemia presenting with bilateral facial palsy, who was previously diagnosed with idiopathic facial palsy and treated with steroids. This rare presentation of acute lymphoblastic leukemia should be kept in mind as a diagnostic possibility in a patient with bilateral facial nerve paralysis.
A Scoping Review of Otologic Manifestations of Hematologic Malignancies
2024, Otology and Neurotology

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PaperAcute myelogenous leukemia presenting as facial nerve palsy. A case report

Summary

Mastoid chloroma as relapse in acute myeloid leukaemia

J. Laryngol. Otol.

Aural manifestations of leukemia

Arch. Otolaryngol.

Acute leukemia presenting as acute otitis media

Arch. Otolaryngol.

Leukemia

Facial diplegia

Arch. Otolaryngol.

Otological manifestations of leukemia

Laryngoscope

Paper
Acute myelogenous leukemia presenting as facial nerve palsy. A case report