Disclosures: Kelsey Lau, DO: No financial relationships or conflicts of interest

Case Diagnosis: 35 year old male with newly diagnosed acute myeloid leukemia (AML)

Case Description: 35-year-old male presented to the emergency department with fatigue, headache and slurred speech. MRI brain was unremarkable. Based on flow cytometry, the patient was diagnosed with AML, monocytic differentiation. Cerebrospinal fluid revealed 3.5% atypical lymphocytes. CT neck soft tissue demonstrated enlargement of bilateral styloid processes extending to the hyoid bone. He was treated with VII+ III (cytarabine + idarubicin) and intrathecal methotrexate. The patient experienced functional decline and upon admission to an IRF, had bilateral cranial nerve seven palsies. Exam was notable for inability to achieve eyelid closure, smile, purse lips or blow out cheeks. Neurology documented that the patient’s cerebral spinal fluid (CSF) had large myeloid cells with similar staining pattern to his myeloid neoplasm. Ultimately, his bilateral facial nerve palsy was attributed to peripheral nervous system (PNS) involvement of AML.

Setting: Inpatient Rehabilitation Facility (IRF)Assessment/

Results: Patient worked with speech therapy on facial range of motion and displayed improved speech intelligibility and oral motor control. Artificial tears were prescribed for abrasion prevention in context of weak eyelid closure. At discharge, he was independent with bed mobility, walking three hundred feet supervision, min assist for transfers.

Discussion: Neuroleukemiosis, leukemic infiltration of the peripheral nervous system, is a rare presenting symptom of AML. Neuroleukemiosis of cranial nerves most commonly occurs in CN III, IV, VI, VII. Negative CSF cytology does not rule out PNS involvement. CT findings of styloid enlargement can point to AML as cause of facial palsy. It is important to be aware of this rare manifestation of AML, as facial palsy can have a wide differential.

Conclusion: This case draws attention to a rare presenting symptom of AML, bilateral facial nerve palsy, in the cancer rehabilitation population.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-rare-case-of-bilateral-facial-palsy-in-setting-of-newly-diagnosed-aml-a-case-report/