SHM Converge Scientific Abstract ePoster Gallery-Chronic Lymphocytic Leukemia With Rare Progression Involving the Central Nervous System

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This case describes a patient with chronic lymphocytic leukemia (CLL) who developed altered mental status and gait instability over one month. Initial head CT was normal, and MRI showed diffuse nonspecific white matter changes without enhancement. Because the neurologic findings could have reflected chemotherapy toxicity, PRES, PML, or infection, a broad evaluation was performed. Infectious testing was negative, and lumbar puncture revealed atypical lymphocytes, elevated CSF protein, and monoclonal CD5-positive B cells with lambda light chain restriction on flow cytometry, confirming CNS involvement by CLL.<br /><br />CNS disease in CLL is rare clinically, reported in only 0.4–2% of cases, but may be underdiagnosed because symptoms are nonspecific and imaging is often unrevealing. CSF flow cytometry is emphasized as the diagnostic gold standard. Risk factors for CNS progression may include certain molecular abnormalities such as del(17p), TP53, and NOTCH1 mutations, as well as prior CNS injury.<br /><br />The patient was treated with acalabrutinib and dexamethasone, followed by venetoclax five days later, and experienced significant improvement back to baseline mentation. The case highlights that neurologic symptoms in CLL patients should prompt a low threshold for lumbar puncture, since CNS involvement can mimic infection, drug toxicity, metabolic causes, or Richter transformation. Early recognition is important because CNS involvement suggests more aggressive disease and affects treatment decisions.

Asset Subtitle

Kailey E. Knopf

Meta Tag

Author List Alexis L. Giosa, Jarred Burkart, Jennifer Woyach, John Weis, Kailey E. Knopf

Category Clinical Vignettes

Concept Central Nervous System Involvement

Concept Chronic Lymphocytic Leukemia

Concept Diagnosis

Concept Lumbar Puncture

Concept Cerebrospinal Fluid

Distinguished Non-Finalist

Presenter Organization OhioHealth Riverside Methodist

Presenting Author Kailey E. Knopf

Track Adult

Keywords

chronic lymphocytic leukemia

CNS involvement

altered mental status

gait instability

CSF flow cytometry

monoclonal B cells

white matter changes

acalabrutinib

venetoclax

PRES

Central Nervous System Involvement

Chronic Lymphocytic Leukemia

Diagnosis

Lumbar Puncture

Cerebrospinal Fluid