Bilateral facial nerve palsy as first indication of relapsing hairy cell leukemia after 36 years
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Hairy cell leukemia (HCL) is a rare B-cell neoplasm comprising about 2% of lymphoid leukemias1 with a pronounced male predominance.1–3⇓⇓ The majority of patients present with splenomegaly, pancytopenia, and circulating hairy cells in the peripheral blood.2–4⇓⇓ Peripheral lymphadenopathy is rare but may be encountered on CT imaging in up to 30% of patients.2 Modern therapies, especially application of cladribine (2CdA), lead to durable complete remissions even after one single course of treatment.2–4⇓⇓
Neurologic complications from HCL have been reported anecdotally.5–7⇓⇓ In these cases, leukemic meningitis5,6⇓ and influx of hairy cells into the CSF as a transient phenomenon due to disruption of the blood–brain barrier by infection7 were described.
Case report.
A healthy 76-year-old woman developed acute-onset lacrimation of the left eye. Worsening symptoms including deficit in the innervation of the left corner …
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