SHM Converge Scientific Abstract ePoster Gallery-Longitudinally Extensive Transverse Myelitis (Letm) and Cmml, Unheard Of, Rare but Possible

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This case report describes a rare association between chronic myelomonocytic leukemia (CMML) and longitudinally extensive transverse myelitis (LETM), a severe inflammatory spinal cord syndrome more commonly linked to autoimmune diseases such as neuromyelitis optica spectrum disorder (NMOSD) or multiple sclerosis.<br /><br />A 71-year-old man with hypertension, atrial fibrillation, hyperlipidemia, psoriasis treated with etanercept, and other medical problems was admitted with anemia, shortness of breath, and splenomegaly. During hospitalization, he developed sudden numbness in both legs that rapidly progressed to flaccid paraplegia with loss of reflexes and severe weakness. Neurologic exam showed 0/5 strength in the lower extremities and sensory loss, while joint position sense was preserved.<br /><br />MRI of the thoracic spine revealed a long segment of expansile T2 signal abnormality extending from T5–T6 to T11–T12, mainly involving the central cord with peripheral sparing. The appearance was consistent with LETM. Differential diagnoses included NMOSD, autoimmune myelitis, paraneoplastic myelitis, infection, and spinal cord infarction. Extensive testing, including autoimmune, infectious, and demyelinating workup, was negative. CMML was diagnosed based on WHO criteria, making paraneoplastic myelitis the most likely explanation.<br /><br />Treatment with steroids, plasma exchange, and IVIG led to only mild improvement, but the addition of rituximab plus aggressive physical therapy produced substantial recovery. One month later, MRI showed near-complete resolution of the spinal cord abnormalities. Over six to seven months, the patient regained leg strength and became ambulatory.<br /><br />The authors conclude that although rare, CMML can be associated with paraneoplastic LETM, and timely immunotherapy plus rehabilitation may lead to meaningful neurologic recovery.

Asset Subtitle

Mohamad Karim

Meta Tag

Author List Jigar Mankad, Jonathan Barnett, Mohamad Karim, Sivaramakrishna Cheetirala

Category Clinical Vignettes

Concept Longitudinally Extensive Transverse Myelitis

Concept Paraneoplastic Syndrome

Concept Chronic Myelomonocytic Leukemia

Concept Neuromyelitis Optica Spectrum Disorder

Concept MRI Spine

Distinguished Non-Finalist

Presenter Organization University of Wisconsin School of Medicine and Public Health

Presenting Author Mohamad Karim

Track Adult

Keywords

chronic myelomonocytic leukemia

CMML

longitudinally extensive transverse myelitis

LETM

paraneoplastic myelitis

spinal cord inflammation

neuromyelitis optica spectrum disorder

MRI thoracic spine

rituximab

neurologic recovery

Longitudinally Extensive Transverse Myelitis

Paraneoplastic Syndrome

Chronic Myelomonocytic Leukemia

Neuromyelitis Optica Spectrum Disorder

MRI Spine