A 16-year-old male patient was admitted to the Hematology Department with a common ALL (Pallphia negative).
Induction with ALL scheme 15-30 according to protocol, with rapid response and complete remission.
In the consolidation stage, a triple IQ was started (Metrotrexate 15 mg, Cytarabine 50 mg, Betamethasone 4 mg).
Neutropenia appeared during this stage and the myelogram showed 71% lymphoblasts and presence of blasts in CSF, without neurological symptoms.
Early combined relapse was defined.
In rescue therapy, he received six IQ pulses, achieving complete remission and disappearance of CSF blasts.
At eight months he continued with block R2.
After the first intrathecal procedure, gait instability was initiated.
The neurological examination showed a patient alert, oriented, without alteration of cranial nerves, or muscle power, Contradicted Ranking, unsafe gait, positive Romberg and such alteration normal axis IIS, index test
Tiamine 90 mg c/12 h, Pioxine 150 mg c/12 h, Leuvorin 50 mg c/12 h, Cyanothionine-aden chemotherapy ampoulesylme and S/24 h were discontinued.
Two days later the patient watched with preserved upper functions, progressed to gait instability, adding tactile hypoesthesia, difficulty standing for proximal weakness of urinary incontinence, Babinski hyperreflexia.
MRI showed signal increase in posterior cords from cervical to T11.
On the sixth day, there was an increase in weakness in the lower limbs and abdominal wall, extinguished ORR, Babinski, self-harm persisted, and pain sensitivity was preserved, with no compromise in SSESS.
On the 19th day, the patient had paraplegia had abolished OTR, with no sensory level.
A complete blood count with a leukemic relapse on the tenth day indicated palliative care at home.
Neurological involvement did not progress and the patient died of ALL.
